COIN: Center for Mental Healthcare and Outcomes Research (CeMHOR); North Little Rock, AR

Director: Richard Owen, M.D.

About the COIN

CeMHOR's mission is to optimize the health and well-being of Veterans through innovative research to improve access to and engagement in evidence-based mental health/substance use disorder (MH/SUD) care and prevent suicide.

Research Focus Area and Goals

The Center’s research focus is to improve Veterans’ access to mental health (MH) and substance use disorder (SUD) care. Within this focus, the Center’s goal is to improve access to mental healthcare for Veterans with MH/SUDs, with an emphasis on those at high risk for suicide and Veterans living in rural areas.

Research to Impact for VeteRans (RIVRs)

The Research to Impact for VeteRans (RIVRs) program is a new HSR&D funding mechanism that gives researchers the opportunity to pursue a five-year impact goal. Each RIVR impact goal aligns with VA priority areas including VA legislative priorities (e.g., MISSION Act); cross-cutting ORD priorities (e.g. PTSD); other HSR&D defined clinical priorities (e.g. Health Equity); and HSR&D methodological priorities (e.g. Data Sciences, Implementation Sciences, Systems Engineering). Impact goals for RIVRS could include changes in VA policy or clinical guidelines, spread of operational processes across VISNs, scaling of an effective intervention to 2-3 additional sites, advancements in health services research methods, or any other impacts that have real-world effects on Veteran health and satisfaction.

Current RIVR project

Addressing Barriers to Mental Health Treatment Initiation and Engagement

Principal Investigator: Jeffrey Pyne, MD

The goal of this project is to increase rates of initiation and engagement in care for Veterans presenting to VA primary care with unmet need for mental health treatment. Unmet need will be defined as screening positive for PTSD and/or problem alcohol use in VA primary care and having one or no mental health visits in the six months following the positive screen(s). Investigators will meet this need by identifying barriers associated with the Veteran’s preferred mental health treatment and addressing these barriers using a peer specialist (PS)-delivered treatment initiation and engagement intervention. Investigators will monitor initial success by measuring changes in mental health treatment initiation (e.g., an initial visit) and engagement (e.g., number of sessions attended), treatment satisfaction, and mental health symptom severity. In addition, investigators will develop a toolkit to help operations partners scale up this intervention, should it be shown to be effective, and will work with Peer Services leadership in the Office of Mental Health and Suicide Prevention to add a community track for PS advancement.

Center Objectives

In order to achieve CeMOHR’s goals, Center investigators have four objectives.

• Develop and test instruments and strategies to measure Veterans’ perceptions and preferences regarding access to MH/SUD care. Validated tools are essential to measure Veterans’ perceptions, preferences, and satisfaction regarding access to MH/SUD care. The CeMHOR Collaborative Research to Enhance Transformation and Excellence (CREATE), led by Jeffrey Pyne, MD, has developed and validated the Perceived Access Inventory (PAI) to identify factors that impact Veterans’ perception of access to VA mental healthcare and mental healthcare provided via the VA Choice program. The CREATE project findings to date note that PAI scores are strongly correlated with Veterans’ satisfaction with VA MH/SUD care, but further work is needed to understand the relationship between PAI and service utilization.

• Design and test interventions that incorporate innovative strategies, including Veterans’ perceptions and preferences regarding care, to improve Veterans’ access to and utilization of evidence-based MH/SUD care. Recognizing that validated measures are essential, but not sufficient, to improve access to care, CeMHOR investigators develop and test strategies to incorporate Veterans’ perceptions and preferences regarding strategies to improve access to high-quality, evidence-based MH/SUD care.

• Develop patient-centered strategies to decrease risks of suicide and self-harm among Veterans. Access to care and suicide prevention are inextricably linked. Suicide reduction is the major VA clinical priority. MH/SUDs are highly correlated with suicide and self-harm. A minority of Veterans who complete suicide received VA care in the previous two years. This suggests that improving access to and utilization of MH/SUD care among Veterans in need is critical to decreasing suicide in this population.

• Develop strategies for implementing evidence-based practices to improve access to MH/SUD care, especially among Veterans at high risk for suicide and those living in rural areas. After developing and testing instruments and strategies to improve access to care, it is essential to also develop effective practices for their To this end, CeMHOR investigators leverage their partnerships with the Behavioral Health Quality Enhancement Research Initiative (QUERI), the Virtual Specialty Care QUERI, and CeMHOR’s program partners to identify effective practices for implementing strategies that improve access to MH/SUD care.

Additional Programs

CeMHOR supports investigators who are part of the HSR&D (CREATE) Initiative. The North Little Rock site of this CREATE Initiative is focused on improving rural Veterans’ access/engagement in evidence-based mental healthcare.

The Center is also home to the VA Quality Enhancement Research Initiative for Team-Based Behavioral Health program, which enhances team-based care for Veterans with behavioral health conditions. The program’s specific aims are to:

• Understand and enhance coordination, quality, equity, and outcomes of care for Veterans treated within interdisciplinary VA treatment teams and via shared care across healthcare disciplines;
• Advance measurement-based care delivery strategies that enhance personalized, proactive, and patient-driven care for Veterans; and
• Advance implementation science by developing, evaluating, and refining new tools and resources to support the use of facilitation to implement clinical programs and practices that are responsive to VA priorities.

Each COIN works closely with operational partners throughout the VA healthcare system. CeMHOR's partners include:

• The Office of Mental Health and Suicide Prevention (OMHSP)
• Office of Rural Health (ORH)
• Office of Primary Care
• Office of Veterans Access to Care (OVAC)
• South Central VA Health Care Network, VISN 16 and VISN 16 Mental Health Product Line
• South Central Mental Illness Research, Education & Clinical Center

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