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
- Huang, H., Chan, Y.-F., Katon, W., Tabb, K., Sieu, N., Bauer, A. M., Wasse, J. K., & Unützer, J. (2012). Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groupsV. Family Practice, 29(4), 394–400. https://doi.org/10.1093/fampra/cmr108
- Huang, H., Bauer, A. M., Wasse, J. K., Ratzliff, A., Chan, Y.-F., Harrison, D., & Unützer, J. (2013). Care managers’ experiences in a collaborative care program for high risk mothers with depression. Psychosomatics, 54(3), 272–276. https://doi.org/10.1016/j.psym.2012.07.011
The number of older adults is rising sharply and is expected to increase from 40.3 million to 72.1 million between 2010 and 2030. According to the Pew Research Center, 92% of adults aged 65 and older use text messaging. Despite misconceptions to the contrary, text messaging as part of primary care for older adults is growing. Text messaging holds promise as a strategy for engaging older adults in Collaborative Care depression treatment through frequent contact with a behavioral health care manager. The purpose of this research project is to develop and pilot test a text messaging intervention delivered in California primary care settings serving a patient population that is at least 25% older adults. Published research (Bao et. al. 2015) demonstrated that early follow-up contact predicts better clinical outcomes for patients. A recent analysis published by the AIMS Center (Renn et. al. 2021) showed that Collaborative Care was equally effective in older and younger adults but that older adults needed more contact with the behavioral health care manager to achieve these equivalent outcomes. Text messaging may be an effective strategy for both early and more frequent contact with patients. The AIMS Center is partnering with the Archstone Foundation on this project.
This NIMH funded project is a collaboration between the University of Washington, Emory University and three sites in India (Chennai, Delhi, and Vishakapatnam). This grant will adapt the multicondition TEAMcare model to treat patients with poorly controlled diabetes and comorbid depression at these three sites and build on an National Heart, Lung and Blood Institute Center for Excellence grant established in India by Emory University. An initial one year qualitative study will help our research team adapt TEAMcare to the unique aspects of Indian culture and medical systems.
Link for TEAMcare: http://www.teamcarehealth.org/
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.
This project was borne of a unique partnership between two federal entities, HRSA and NIMH, who contracted with the AIMS Center to train and support care teams in Nurse-led clinics to implement Collaborative Care. The project began in 2017 with11 clinics in diverse regions of the US for two years. All the sites were safety-net clinics providing care to underserved, predominantly uninsured patient populations, and were located in rural, suburban, and urban areas. Target populations included low-income, homeless, and/or LGBTQ adults facing significant financial, geographic, cultural-linguistics barriers. Patients served in these clinics suffered from chronic disease conditions (e.g. diabetes, hypertension) and untreated/undertreated mental health conditions or substance abuse.
AIMS Center practice coaches provided individualized support to each clinic as they laid the groundwork for their Collaborative Care teams, which included hiring staff, developing workflows, and financial planning. Teams had highly variable staffing models and experience with integrated care, but after several months of remote team meetings and didactic webinars with practice coaches, in-person trainings, and site visits, all 11 sites launched Collaborative Care in early 2018. Each site then received ongoing clinical training for behavioral health care managers and psychiatric consultants, as well as monthly sessions with a practice coach to refine workflows and team communications, report on and improve quality metrics, and plan for financial and clinical sustainment.
A unique aspect of this project is that site visits were conducted early in Year Two of the project, and a formalized set of evaluation tools were developed and used to assess site progress and identify areas in need of support. The site visits were conducted by the AIMS practice coach and clinical trainers and thoroughly documented for reporting back to HRSA and NIMH, as well as to the sites themselves. This was a rich method for thoroughly understanding any implementation challenges these sites faced and helping them solve these problems in real time. The project concluded in June of 2019.
This NIMH-HRSA collaboration supported Strategic Objective Four (4) of the NIMH Strategic Plan, which is to strengthen the public health impact of NIMH-supported research by providing training and health information dissemination.
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.