Rural Mental Health Integration Initiative

Poor mental health is a major public health issue, affecting millions of people in their pursuit to lead optimal emotional, social, and professional lives. Depression alone can worsen other medical conditions, often doubling over-all healthcare costs, and result in a significant decrease in quality of life and overall functioning.

Rural communities and residents of those communities face significant social and health disparities as compared with urban and suburban residents. Residents of rural areas are more likely to experience health disparities. They are more likely to have chronic health conditions, less likely to receive healthcare of any kind, and less likely to receive evidence-based treatments when they do access care. Geographic maldistribution of mental health specialists from all disciplines and education levels (e.g. psychology, social work, psychiatry) creates significant access challenges. Rural areas also experience workforce shortages for primary care, where most rural mental health treatment occurs, further exacerbating access barriers. In underserved rural areas in Washington and Alaska, a severe shortage of mental health providers compounds these problems.

In an effort to ameliorate some of these disparities, the AIMS Center is partnering with Premera Blue Cross to support 23 clinics in rural Washington and Alaska to implement Collaborative Care.

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ruralmh@uw.edu

St. Luke’s Health System Collaborative Care Implementation

The AIMS Center provided training and technical assistance to St. Luke’s Health System as they implemented a Collaborative Care program in April 2017.  This implementation took place over 12 months and included three clinics in spring 2017 and two clinics in fall 2017. Eventually collaborative care will be spread across the entire of network of clinics at St. Luke’s Health System, the only Idaho-based, not-for-profit health system. 

New York State Learning Network

The New York State Office of Mental Health (OMH) asked Performing Provider Systems (PPSs) from all over the state that chose Collaborative Care for their Delivery System Reform Incentive Program (DSRIP) to nominate at least one of their clinics to participate in the Learning Network. Through a rigorous application process, 19 clinics were selected to participate. As a part of the Learning Network, these clinics will eventually be eligible to bill the monthly Medicaid case rate once they are trained and have the necessary staffing, infrastructure, and workflows in place to deliver effective Collaborative Care (CoCM).

In order to achieve these goals, OMH provided clinics with training, site visits, and access to tools that facilitate the implementation of Collaborative Care, including access to the AIMS Center’s Care Management Tracking System.
While Collaborative Care training and support provided by OMH is only available to these clinics for one year, OMH hopes that creating a network of clinics learning together will facilitate the success of Collaborative Care for clinics beyond additional training support. As part of the Learning Network, clinics are encouraged to build relationships with the other clinics through communicating and learning from one another along the way. Individual clinics are matched with similarly structured clinics to form several training cohorts to better facilitate learning. An experienced coach works with each training cohort throughout the implementation process. Regular calls with the training cohort will keep clinics connected and provide the opportunity to receive additional training support, discuss challenges, and learn what the other sites are doing.

The AIMS Center, NYS OMH, Qualis Health, and, most importantly, the training cohorts will provide clinics with the support and tools needed to ensure a successful CoCM program implementation. We hope that each clinic’s care team will continue to communicate with the other members of the learning network after the close of the year and the discontinuation of services.

Behavioral Health Integration Program (BHIP)

In an effort to increase access to mental health care in Seattle and King County, the AIMS Center at the University of Washington partnered with UW Medicine to launch the Behavioral Health Integration Program (BHIP). BHIP uses collaborative care to bring mental health treatment into all of the UW Neighborhood Clinics, a system of twelve primary care clinics located throughout greater Seattle, as well as clinics at Harborview Medical Center and the General Internal Medicine clinic at UWMC Roosevelt. Like elsewhere, mental health is a big part of primary care in Seattle and King County; in 2009, 19% of all clinic patients had a mental health diagnosis. Although Collaborative Care has been implemented around the world, the AIMS Center and UW Medicine are very proud to be able to provide it in our own community.

BHIP utilizes a web-based Care Management Tracking System that supports population-based care, provides patient outcome measures, and assists in quality improvement efforts. In October 2012, several goals were established for the BHIP program: to increase patient access by care managers and across all BHIP clinics, to improve patient outcomes on measures of depression and anxiety, to increase provider satisfaction with care management, and to improve provider satisfaction with psychiatric consultation. When measured in August 2013, the BHIP program had exceeded initial targets for each of the seven indicators.

BHIP won a Psychiatric Services Achievement Award from the American Psychiatric Association in 2014, and a Washington Award of Excellence in Healthcare Quality from Qualis Health in 2016.

Care Partners: Bridging Families, Clinics, and Communities to Advance Late-Life Depression Care

Through Archstone Foundation’s Depression in Late Life Initiative, the Care Partners project seeks to improve depression care for older adults by building innovative and effective community partnerships. Specifically, the Care Partners project has the following goals: 1) develop late-life depression innovations among primary care, community-based organizations (CBOs) and family, 2) build a learning community of clinics, CBOs, and researchers in California who will work together on the Care Partners Late-Life Depression Initiative to improve care for depressed older adults, 3) conduct an evaluation of the developing models, and 4) develop and conduct a Learning Collaborative in Year 5 for California clinics and CBOs interested in improving depression care for older adults. Throughout the project, project teams at the University of Washington (UW) and UC-Davis (UCD) provide technical assistance and evaluation to support site development and sustainment. Together, the community-engaged partnerships have tremendous potential to improve access to care, patient engagement, patient care experience and quality of care. In addition, CBO and clinic partners are well primed to improve care through addressing the social determinants of health.

Collaborative Care for Pregnant People and Primary Caregivers in Lower Income Communities

Untreated mental health illnesses have serious consequences for families, but fewer than one in four depressed people who identify as mothers receive effective treatment. This project examined depression care and clinical outcomes for pregnant people and people who identify as either mothers or primary caregivers, treated in 14 clinics serving racially and ethnically diverse communities with lower incomes as part of the Mental Health Integration Program (MHIP). The outcome of this project was published in Family Practice. Huang H. et al (2012) found that although there was substantial depression improvement in all four of the ethnic groups studied (Asian, Black, Latinx, White), outcomes of Latinx patients were higher than those of Black patients regardless of other demographic or clinical factors. Notably, this study shows that more intensive care management in the first month of treatment for primary care can lead to better outcomes for pregnant people, and mothers or primary caregivers with lower incomes experiencing depression. Another study describes the experiences of care managers working in this program and found that motivational interviewing skills were a valuable asset in engaging patients in care, which generally leads to better outcomes.

References