Measurement-based care implementation in a Veterans Affairs primary care-mental health integration program.

Measurement-based care (MBC) in behavioral health is the systematic use of validated measurement tools to guide clinical decision making and collaborative treatment planning. Although benefits of MBC for clinicians and patients have been supported by research, it appears to be underutilized in clinical settings. This study examined the effectiveness of a MBC implementation plan informed by the theory of planned behavior in a large, integrated primary care program at a Veterans Affairs hospital over 18 months. Multiple methods, including self-report clinician data and aggregated clinic data, were used to examine change in clinician MBC-related behaviors over time. Results demonstrated both an increase in symptom measures administered per clinical encounter and per individual patient treated. Additionally, the ratio of individuals receiving at least one symptom rating measure to total number of patients treated decreased over time, demonstrating increased use of MBC by integrated primary care clinicians. Survey data demonstrated upward trends in administering measures at initial assessment and at treatment termination, and clinician attitudes toward MBC were generally positive. Results corroborate the theory of planned behavior as a model in which to guide systematic MBC implementation. MBC implementation challenges and recommendations are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Engagement in mental health treatment following primary care mental health integration contact.

Although the majority of mental health conditions are treated in primary care, treatment provided in this setting is often inadequate. In response to this problem, integrated mental health programs were created to enhance direct patient care and increase support for primary care providers. Data on the efficacy of these programs have suggested improved access, treatment outcomes, and patient satisfaction. However, infrequently examined is how interaction with integrated mental health providers impacts completion of referrals to specialty mental health (SMH) programs for patients whose treatment needs are too severe to treat in primary care alone. The current study examined referral acceptance rates among a veteran population at a large Midwest Veterans Affairs (VA) medical center. Results found that completion rates to SMH following integrated mental health contact (87.1%) were higher than published comparisons (32% in 1 study). It was found that a large proportion of these veterans maintained continued attendance to SMH treatment at 1- and 6-month follow-up (88.9% and 71.9%, respectively). Finally, data also suggest that only a small amount of contact (5 or more minutes) was needed to significantly increase the likelihood of SMH referral success but was not related to improved continued attendance in treatment at follow-up intervals. Clinical implications and suggestions for future research are discussed. (PsycINFO Database Record