Targeted Condition: Depression

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.

TEAMcare

Health care providers and systems need effective strategies for management of individuals with multiple coexisting chronic conditions, who are now the norm rather the exception. Among patients with diabetes, the presence of co-morbid depression is associated with increased risk of complications, cardiovascular events and mortality—and higher medical costs. The TEAMcare study was a randomized controlled trial that demonstrated the effectiveness of the collaborative care model (CoCM) for treatment of depression, diabetes, and coronary heart disease in primary care. This multi-center trial was conducted by the University of Washington in collaboration with the Group Health Research Institute with funding from the National Institute of Mental Health (NIMH).

The TEAMcare findings were published in the New England Journal of Medicine in 2010. The primary result was that (when compared to usual care) a multi-disciplinary team providing measurement-based care and nurse care management significantly improved outcomes for depression and coronary heart disease and/or diabetes at a lower cost over a 12-month treatment period.

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

Whole Person Integrated Texting for Health (WITH)

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.

Collaborative Care for Depression and Diabetes in India

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/

Kaiser Permanente

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 Maternal Infant Dyad Implementation (MInD-I) Initiative

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.