This implementation is part of California’s Mental Health Services Act and LA County’s Prevention and Early Intervention (PEI) Plan. The PEI Plan focuses on prevention and early intervention services, education, support, and outreach to help inform and identify individuals and their families who may be affected by some level of mental health issue. The Mental Health Integrated Care Program in particular targets adults with depression, anxiety, and mild to moderate PTSD. Providing mental health education, outreach and early identification (prior to diagnosis) can mitigate costly negative long-term outcomes for mental health consumers and their families.
Practice Type: Primary Care
Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND)
DIAMOND was a collaborative effort of 9 health plans, 25 medical groups, and over 80 primary care clinics in Minnesota to implement and study Collaborative Care for depression. The AIMS Center provided consultation and coaching for the initiative. In addition, the National Institute of Mental Health (NIMH) awarded a $3 million grant to HealthPartners Research Foundation to study the DIAMOND initiative over five years. The study evaluated all aspects of DIAMOND, including effects of the program on patient satisfaction, productivity, and program cost-effectiveness. The project used a patient registry that tracks and measures patient goals and clinical outcomes, and facilitates treatment adjustment if a patient is not improving as expected.
Alaska Integrated Care for Depression and Substance Abuse
The Alaska Mental Health Trust Authority provided pilot funding to a Federally Qualified Health Center in Anchorage to support implementation of Collaborative Care and two Alaska Native tribal health corporations to support implementation of Collaborative Care and SBIRT (Substance Brief Intervention and Referral to Treatment). The purpose of this program was to determine if integrated mental health care can be effective given the unique challenges faced by primary care clinics in Alaska.
Texas Integrated Health Care Program
The AIMS Center provided training and coaching to five primary care organizations in Texas to implement integrated care for the two mental health conditions most commonly encountered in primary care: depression and anxiety disorders.
A study evaluating outcomes of this program found that vastly different organizations were all able to integrate mental health into primary care settings that serve disadvantaged communities. All five organizations in this program showed meaningful improvement in patient depression outcomes, regardless of varying patient characteristics. Sites that achieved the best patient outcomes engaged patients early, with multiple care manager contacts in the first 3 months of treatment, and received consultation and supervision from psychiatric providers.
Reference
Bauer, A. M., Azzone, V., Goldman, H. H., Alexander, L., Unützer, J., Coleman-Beattie, B., & Frank, R. G. (2011). Evaluating the implementation of collaborative depression management in community-based primary care clinics. Psychiatric Services. 62(9), 1047–1053. https://doi.org/10.1176/appi.ps.62.9.1047
Dulce + IMPACT: Combining depression and diabetes care management
This research project combined IMPACT depression care management with an existing diabetes care management program for low income, predominantly Spanish-speaking Latinx people in San Diego. The study shows that this combined approach is both effective and cost-effective with this population.
Building Collaborative Care in New Orleans
When hurricanes Katrina and Rita devasted New Orleans, the AIMS Center worked on a Red Cross funded initiative to rebuild the primary care system to include Collaborative Care. The project enhanced the availability of evidence-based mental health services to uninsured, disadvantaged, and minority community members offered through REACH NOLA’s Mental Health Infrastructure and Training Project. It also showed the benefits of integrated mental health care after disasters, particularly for depression and post-traumatic stress disorder (PTSD). To our knowledge, the program is the first time that a Collaborative-Care-based quality improvement approach for mental health treatment had been applied in a post-disaster recovery setting.
Alameda Health Consortium
Alameda County in California provides affordable health care to its uninsured residents, but primary care clinics struggle to meet the demand. The AIMS Center, in partnership with the Alameda Health Consortium, helped 30 primary care clinics develop an integrated mental health care initiative targeting depression, anxiety, and PTSD to increase the effectiveness of care. A key component of the project was determining how organizations can successfully use funding from Medicaid to implement Collaborative Care.
New York State Collaborative Care Initiative
The New York State Collaborative Care Initiative helped primary care residents learn how to effectively practice team-based care to treat mental health conditions, a skill that has become increasingly important as integrated care becomes more widespread. Outpatient clinics associated with teaching hospitals are implementing Collaborative Care around the state, increasing the quality of mental health care for thousands of New Yorkers. By providing different intensities of technical assistance, the AIMS Center evaluated what level of support was needed to effectively help organizations implement Collaborative Care. They helped set up a technical assistance team in New York to provide on-site assistance to six clinics. Twenty other hospital organziations received web-based technical assistance, including webinars and online tools. Organizations used a patient registry to track and measure patient goals and clinical outcomes, and facilitate treatment adjustment if a patient is not improving as expected.
Mental Health Integration Program (MHIP)
The Mental Health Integration Program (MHIP), supported and administered by the Community Health Plan of Washington in partnership with Public Health -Seattle and King County, integrates mental health screening and treatment in a collaborative care model (CoCM), including psychiatric case review and consultation. MHIP collaborative care teams in Washington State safety-net primary care settings serve diverse Medicaid and uninsured populations. Since MHIP’s inception in 2007, over 50,000 individuals have received integrated mental health services. In 2007 it began as a state-funded, two-county pilot for high risk uninsured adults in King and Pierce counties, but MHIP expanded statewide in early 2009 to include over 130 primary care clinics.
MHIP uses a patient registry (CMTS) to track and measure patient goals and clinical outcomes, and facilitate treatment adjustment if a patient is not improving as expected. MHIP also utilizes pay-for-performance mechanisms to support model fidelity and prioritize patient outcomes. Training and workforce efforts for this project focus on the whole team and all providers are trained on the fundamentals of CoCM.
Project Management
- Community Health Plan of Washington, Stephanie Shushan
- Public Health Seattle-King County, Anne Meegan
COMPASS (Care of Mental, Physical and Substance Use Syndromes)
The COMPASS (Care Of Mental, Physical And Substance-use Syndromes) initiative, funded by the Center for Medicare & Medicaid Innovation, evaluated the large-scale implementation of the TEAMcare model treating patients with depression and comorbid diabetes and/or cardiovascular disease. The initiative was implemented in 18 medical groups and 172 clinics across eight states. Participating clinics differed significantly in size, organizational structure, patient populations, and payment systems, thus demonstrating the feasibility of implementing the TEAMcare intervention in “real world” clinical settings.
The initiative involved 3,609 Medicare and Medicaid patients in eight states and is one of the largest collaborative care implementations to date. The results of the trial were published in a 2016 issue of General Hospital Psychiatry. Among patients with uncontrolled disease at enrollment, 40% achieved depression response or remission, 23% achieved glucose control and 58% achieved blood pressure control over the 11-month treatment period. There were large variations in outcomes across the medical groups, and rigorous implementation was associated with increased effectiveness. Researchers learned best practices for treating patients in primary care settings who have multiple chronic conditions, demonstrated the model can be effective for the target population when implemented well, and identified financial models that can sustain and scale a multi-condition collaborative care program.