3156 — Substance Use Disorder Treatment in Integrated Primary Care Mental Health

Zubkoff L, White River Junction VA Medical Center; Shiner B, White River Junction VA Medical Center; Carpenter-Song E, Geisel School of Medicine; Watts BB, White River Junction VA Medical Center;

Objectives:
Substance use disorders (SUDs) are common among Veterans. Treatment for SUDs can be delivered in a variety of settings, ranging from primary care to specialty clinics. Primary care-mental health integration (PC-MHI) is an existing VA service developed to improve primary care patients' access to mental health treatments. Three PC-MHI service models are endorsed by the VA: 1) Collocated Collaborative Care; 2) Translating Initiatives for Depression into Effective Solutions; and 3) Behavioral Health Laboratory. Treatment of mental health disorders in each of these service models has been well characterized, but little is known about the treatment of SUDs in the PC-MHI setting. We sought to understand the provision of SUD services in PC-MHI clinics; and to identify local barriers and facilitators to providing evidence-based SUDs treatment in PC-MHI clinics and how they relate to choice of service model.

Methods:
We conducted site visits to six VA medical centers with PC-MHI clinics, representing the three VA approved PC-MHI service models. We conducted semi-structured interviews and focus groups with leadership and front-line clinicians to inquire about the operation of the integrated care model, how Veterans with substance use disorders receive services, the types of services offered, how services are tracked, and to identify barriers and facilitators of SUD treatment in the PC-MHI setting. This work was guided by the Consolidated Framework for Implementation Research (CFIR).

Results:
First, there is limited implementation of the pure integrated care models, suggesting there may be limited use for model-specific implementation programs for SUD treatments. Second, the resources and staffing vary considerably between models, suggesting that available resources may necessitate flexible implementation programs that leverage locally available resources. Third, there is considerable variation in the goals and structures of the clinics. Fourth, clinics have very little focus on SUD issues, with most sites concentrating on evaluation and treatment for depression, anxiety, and PTSD. Fifth, PC-MHI staff believe there are few evidence-based treatments for SUDs that are appropriate for the PC-MHI.

Implications:
Despite efforts to offer SUD treatment in the integrated care setting, staff members do not view providing SUD treatment as their duty.

Impacts:
This work provides insight into SUD treatment options in the PC-MHI setting.