3145 — Early implementation of patient-centered, team-based care in mental health: a qualitative evaluation of staff perceptions

Barry CN, Program Evaluation and Resource Center (PERC); Bowersox NW, Serious Mental Illness Treatment and Evaluation Center (SMITREC); Abraham KM, Serious Mental Illness Treatment and Evaluation Center (SMITREC);

Objectives:
To promote a more collaborative approach to outpatient general mental health (MH) care delivery within VHA facilities, the Office of Mental Health Operations (OMHO) developed a standardized, interdisciplinary, team-based model - the Behavioral Health Interdisciplinary Program (BHIP). The BHIP initiative was introduced VHA-wide in August 2013, with the requirement to form one team at each facility, and the extent of implementation varied. Some MH programs transitioned their entire outpatient MH clinics to BHIP teams while others created only one BHIP team as a local pilot. This evaluation was designed to describe and understand major challenges and perceived benefits of early BHIP implementation.

Methods:
OMHO conducted 50 one-on-one semi-structured interviews about planning and establishing BHIP teams with licensed provider, non-licensed provider and clerical staff engaged in BHIP implementation in 21 VHA facilities (one facility per VISN). Facilities were selected through maximum variation sampling, a purposive strategy to maximize sample diversity and capture a wide range of respondent experiences. Interviews occurred between June and August 2014, ten to twelve months after BHIP implementation began.

Results:
Respondents perceived team-based care in outpatient MH as improving staff collaboration and communication and, in turn, improving Veteran treatment planning and care coordination. However, in discussing difficulties with BHIP implementation, many respondents highlighted a need for greater guidance from their MH program leadership to re-organize staff and clinic structures to meet BHIP model expectations. Respondents cited a lack of role clarity and role expectations within the team as a challenge to team functioning. Staff shortages, particularly among registered nurses and clerical staff, also challenged team functioning.

Implications:
Staff experiences of early BHIP implementation confirm the model's potential to improve care delivery and staff working relationships. These experiences also suggest ways to improve future implementation of BHIP team-based care through more active involvement of facility MH clinic leadership, better staffing of teams, and clearer descriptions of team roles.

Impacts:
OMHO will incorporate evaluation findings into efforts to expand and sustain the team-based model of outpatient mental health treatment, which appears to be a promising approach for improving quality of care.