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2015 HSR&D/QUERI National Conference Abstract

3118 — Examining the Experiences of General Mental Health Clinic Staff in Implementing Collaborative Care

Kim B, COIN - Bedford/Boston; Miller CJ, COIN - Bedford/Boston; Elwy AR, COIN - Bedford/Boston; Holmes SK, COIN - Bedford/Boston; Bauer MS, COIN - Bedford/Boston;

In 2013, the Veterans Health Administration (VHA) mandated a nationwide implementation of team-based care in the general mental health setting, called Behavioral Health Interdisciplinary Program (BHIP). As mental health clinic staff are major stakeholders whose practices are most directly affected by this implementation, our objectives were to examine their experiences of delivering collaborative interdisciplinary care to inform national BHIP policy, as well as to identify strategies through which any provider concerns can be addressed.

In January-May 2014, we conducted semi-structured interviews with five psychologists, three advanced practice nurses, two psychiatrists, two registered nurses, and two social workers across three VHA facilities at different stages of BHIP implementation. Interviews were analyzed using grounded thematic analysis, and prominent emergent themes were further analyzed to understand which other themes they were most often associated with.

Communication was viewed as key to collaborating within and outside the team, as well as for sharing organizational priorities. Interviewees from all three sites discussed feeling stressed, not feeling supported in their work, and having a high workload as their main concerns. Inconsistent and unengaged leadership was perceived to be a major contributor to each of these. Lack of resources was seen to negatively affect delivering appropriate care, yet quality improvement efforts to maximize the utility of available resources by eliminating inefficiencies were rarely discussed. Compared to the one site with a fully implemented BHIP, the other two sites had more of their interviewees voicing the importance of colleagues in obtaining information that is not systematically available.

BHIP may help mental health staff foster communication and obtain clinical information more systematically, through the collaboration of multiple disciplines in caring for Veterans. Staff view lack of resources, rather than their inefficient usage, to be preventing them from delivering appropriate collaborative care.

Implementation of new care practices requires not only effective communication and support from leadership, but also concurrent improvement capabilities among staff to notice inefficiencies and take initiative to eliminate them. Maximizing the utility of available implementation resources as such is critical to meeting VHA's imperative to advance value, as outlined under Strategy 2 of the Blueprint for Excellence.