Tools for Implementing Collaborative Care
In United States primary care, helping patients with depression is a daily crisis. Over the past decade, Collaborative Care has emerged as the new standard for depression treatment in primary care. Recommended by the United States Preventive Services Task Force, this model speeds improvement through increased engagement, symptom monitoring and rapid treatment adjustment.
While Collaborative Care is a proven solution to this crisis, implementing it in any medical system exposes unexpected challenges. As an implementation group shapes a Collaborative Care model to fit their local environment, there is no systematic method to determine which parts of the model can be modified or where flexibility might undermine success.
The Core Principles and Tools for Implementing Collaborative Care defines a serviceable framework for making implementation decisions to integrate mental health treatment into primary care. When decision-makers agree not just on goals, but on the core principles those goals are based on, all decisions get filtered through a lens of shared values, and fall into one of two categories: "fidelity required” or “flexibility allowed.” This discrete, shared understanding enables anyone involved to ensure decisions have integrity.
To access the toolkit for free, follow this link.
Addressing Tobacco Dependence in the Behavioral Health System: Training in the “Bucket Approach”
Individuals coping with mental illness and/or other addictions, who use tobacco, are interested in quitting, can quit, but need more support. With funding from the Bureau of Prevention, Treatment, and Recovery in the Wisconsin Department of Health Services, the University of Wisconsin Center for Tobacco Research and Intervention has developed a free, online training to equip behavioral health clinicians with the skills to support patients on their quit journey. Addressing Tobacco Dependence in the Behavioral Health System: Training in the “Bucket Approach” launched in October of 2019 and is based on the Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence. The training is tailored both to the motivational readiness of smokers coping with mental illness and/or addiction, who may need more time and resources to quit, and the busy clinician who has limited time to address tobacco dependence. The training takes a system change approach to tobacco treatment integration and includes information about how to measure outcomes and implementation fidelity.
The Bucket Approach training consists primarily of videos that demonstrate each of the intervention’s clinicians can provide to enhance motivational readiness and success in quitting. The interventions are brief and designed to build upon the skills clinicians already possess. Available at helpusquit.org, the training can be completed at the clinician’s pace and offers up to 8.25 free CE credits. To date, 898 people have enrolled and 446 of these have been from Wisconsin.
Self-Measured Blood Pressure (SMBP) is a strategic method to help patients control their hypertension and determine if undiagnosed patients have hypertension. With clinical support, SMBP has shown to positively effect health system blood pressure control rates. SMBP involves the patient and the clinical care team. The patient uses a portable blood pressure device at home, checking and recording their blood pressure multiple times a day over a matter of several days. The results are then sent to the primary care team where an analysis might include changing the patient’s blood pressure medication or diagnosing them with hypertension if not done so already. When used with home-based blood pressure checks, patient counseling, education and visit follow-ups, patients are more likely to be on track and better understand and manage their hypertension.
Resources that can help your health system kick-start this strategy are the following:
SMBP was discussed during the March Chronic Disease Learning Collaborative meeting and the collaborative will continue to explore new ways to manage chronic conditions in the future. If you would like to be a part of the conversation, contact Jen Koberstein.
Adolescent and Child Health
The WCHQ Adolescent and Child Health Improvement Team focused on child and adolescent mental health at their March meeting. The meeting provided an opportunity to dig deeper into the subject and review resources as members shared their own best practices on addressing mental health among children and adolescents.
Member health systems emphasized the importance of integrated behavioral health when addressing child and adolescent mental health. One member stated they have a pilot program where primary care providers can request a 15-minute consultation between the patient, caregiver, and a psychologist during either a routine or acute appointment. Patients are then scheduled for follow-up behavioral health appointments as needed. Another member discussed the benefits of having a behavioral health consultant on staff as part of the primary care team. Patients are less likely to fall through the cracks with this type of model in place. In addition, it helps patients, who might fear speaking with a stranger or are nervous about the counseling process, better understand the normalcy of talking to someone and that counselors are regular people. One member noted that using their patient portal where patients can fill out their depression screenings ahead of time, allows the care team to prep for the patient’s visit more efficiently.
Resources related to Child and Adolescent Mental Health:
If you’re interested in joining the discussion or the Adolescent and Child Health Improvement Team, please contact Abbey Harburn.