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2006 HSR&D National Meeting Abstract


1028 — Planning Effective Educational Interventions for Clinicians in Complex Mental Health Service Systems

Author List:
Blevins D- (Central Arkansas VA, CeMHOR, South Central MIRECC)
Kauth MR (New Orleans VA, South Central MIRECC)
Henderson K (Central Arkansas VA, Mental Health Product Line)
Mukherjee S (Central Arkansas VA, CeMHOR, South Central MIRECC)
Cody M (VHA Center on Advice and Compliance Help (COACH))
Sullivan G (Central Arkansas VA, CeMHOR, South Central MIRECC)

Objectives:
Consistent with the mental health priorities of the VA’s Action Agenda (2003), two educational interventions were conducted by the South Central (SC) MIRECC to improve the effectiveness and efficiency of mental healthcare in VISN 16. We report how lessons learned from a failed educational intervention were utilized in combination with implementation principles in a second intervention to significantly change practice.

Methods:
The first educational intervention was focused on increasing the use of group therapy in VISN 16. Across the Mental Health Service of ten VAMCs, 142 therapists participated in one of two trainings (video conference: n = 136; workshop: n = 36). The second intervention aimed to increase knowledge and services in psychosocial rehabilitation. Stakeholders were engaged at several levels of the VAMCs, moving away from a top-down approach. Pre-training planning and subsequent coaching were individualized. Participants included 16 clinicians from 9 facilities in VISNs 16 & 17. Mental Health Directors were involved in both interventions, but were more actively engaged in the second intervention.

Results:
At 12-month follow-up of the first intervention, there were no significant differences in proportion of veterans receiving treatment in a group format; evaluation results revealed numerous barriers that prevented a realization of the outcomes, including lack of time and space to initiate new groups. At 12-months following the second intervention, 12 new programs were initiated, and over 350 additional VA personnel had been trained by the participants.

Implications:
The realization of positive outcomes from the second intervention can be attributed to several changes in the implementation approach, including individualized pre-training planning and follow-up activities such as mutually agreed upon goals between participants and their Directors and requiring a formal action plan. Results and intervention approach modifications are discussed within the implementation model by Fixsen et al. (2005).

Impacts:
The literature is replete with examples of well-intentioned educational interventions that failed to have a substantial impact on clinical practice. The approach adopted by the SC-MIRECC, informed by comprehensive program evaluation and implementation principles, can be employed by others throughout the VA system to maximize the effects of educational programs.


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