Health Services Research & Development

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CREATE: Improving Rural Veterans' Access/Engagement in Evidence-Based Mental Healthcare


Director: Jeffrey Pyne, M.D.

Principal Investigators:

About the CREATE

Veterans living in rural areas comprise 41% of all enrollees in the VA healthcare system, and the majority of them receive treatment in one of VA's 833 community-based outpatient clinics (CBOCs). The VA's Office of Rural Health (ORH) is concerned with ensuring that there is no "engagement gap" for rural Veterans needing mental health (MH) services within the CBOC setting. (Engagement is defined as participating in an adequate number of healthcare encounters and self-care activities to achieve a therapeutic effect.) To support that goal, this CREATE seeks to inform VA policy-making and program development by increasing the knowledge base around access to and engagement in evidence-based MH services delivered in CBOCs.

 

Partner Offices

Each CREATE works closely with operational partners throughout the VA system. The partners associated with this CREATE include:

  • John Rader, LCSW, VISN 16 Mental Health Product Line Manager
  • Andrew Pomerantz, M.D., National Mental Health Director, Integrated Services, Office of Mental Health Services

Projects

The individual projects in this CREATE seek to: develop a patient-centered survey instrument to measure Veterans' perceived access to mental health services; test access interventions to increase engagement in MH care at CBOCs; and test clinical interventions to improve quality and outcomes of MH care at CBOCs. Funded projects include:

  • Development and Validation of a Perceived Access Measure
    This project will develop a patient-centered survey instrument to measure perceived access to MH care that Veterans prefer and believe to be effective. Both cultural and digital dimensions of access will be included.
    (PI: Jeffrey Pyne, M.D.)

  • Motivational Coaching to Enhance Mental Health Engagement in Rural Veterans
    This project seeks to improve perceived access to care in order to facilitate Veterans' engagement in their preferred treatment, including e-health services. A multi-site clinical trial will test a motivational coaching intervention designed primarily to address rural cultural access issues (e.g., stigma, lack of trust) perceived by rural Veterans.
    (PI: Karen Seal, M.D., M.P.H.)

  • Adapting and Implementing the Blended Collaborative Care Model in CBOCs
    This project centers around a multi-site trial to test the impact of restructuring MH care in CBOCs, transforming it from a referral-based model into a tele-integrated PC-MHI model. Investigators expect that project results will help establish the clinical effectiveness of adapting PC-MHI models using telemedicine technologies for clinics that do not have onsite psychologists/psychiatrists.
    (Richard Owen, M.D.)

  • A Computer-Assisted Cognitive Behavioral Therapy Tool to Enhance Fidelity in CBOCs
    This project will develop and test a health information technology intervention (computer-assisted psychotherapy) designed to improve the technical quality of care delivered by CBOC psychotherapists.
    (Michael Cucciare, Ph.D.)

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