Breakout J – October 14, 2011 (MC: Katy Thysell)
Presenter: Michael Kauth, PhD
Authors: Geri Adler, and Michael Kauth, VA South Central MIRECC, Central Arkansas Veterans Healthcare System
Abstract: Mental health providers, researchers and systems of care face a great challenge in making evidence-based practices more available to those in need. This is a particular challenge in rural areas where 21% of the US population resides. The VA has opened 791 community-based outpatient clinics (CBOCs), most of which are located in rural areas. These primary care clinics are required to offer mental health care, and each is affiliated with a “parent??? VA medical center. It has become common practice for a “parent??? facility to assist rural CBOCs in delivering mental health care through telemedicine, but the majority of telemedicine involves medication management with little evidence-based psychotherapy delivered via telemedicine. To better understand this discrepancy, we surveyed CBOC-based mental health clinicians regarding actual and perceived barriers to distance psychotherapy. We then developed an external facilitation intervention to encourage adoption of telepsychotherapy and are piloting it at three VA medical centers. In this report, we will 1) describe the needs and concerns of clinicians providing telepsychotherapy, 2) identify organizational barriers and facilitators to telepsychotherapy at the medical centers and CBOCs, and 3) describe our external facilitation intervention to promote adoption of telepsychotherapy and compare and contrast its effectiveness at the sites.
Presenter: Chrisopher Dunn, PhD
Authors: Christopher Dunn, Sarah “Grin” Geiss Trusz, Kristin Bumgardner, Toni Krupski, and Peter Roy-Byrne, University of Washington
Abstract: Training in screening, brief interventions (BI), and referral to treatment for substance abuse is being widely disseminated and implemented in a variety of healthcare settings. Motivational Interviewing (MI) counseling style and method is thought to enhance BI effectiveness. The science of BI-MI training has not yet established optimal training doses for interventionist trainees to reach beginning competence. This study implemented and evaluated two training packages for teaching BI-MI, an 8-week comprehensive and 4-week accelerated training, in primary care medical settings. Interventionist trainees were medical social workers (n = 22) in primary care clinics serving safety net population patients with drug abuse. Trained coders evaluated post-training BI and MI performance during standardized patient role play interviews using a checklist of BI clinical tasks and the Motivational Interviewing Treatment Integrity 3.0 coding system. Both training models yielded similar end-point MI skill levels. The proportions of all learners who reached beginning proficiency on MI skills by the end of training were comparable to those reported in similar MI training outcome studies (between 25% and 65%). Results suggest that some practitioners working in busy medical settings can learn BI and reach beginning proficiency in MI in as little as one month. Adherence to BI content and MITI outcomes with live patients in primary care settings will also be presented.
Presenter: Laura Damschroder, MS, MPH
Author: Laura Damschroder, Ann Arbor VA Center for Clinical Management Research
Abstract: Translating evidence into practice requires that implementation researchers and leaders of clinical QI initiatives understand multi-faceted contextual factors influencing success or failure of implementation. The Consolidated Framework for Implementation Research (CFIR) provides a consolidated and comprehensive implementation taxonomy which can be used to guide data collection, analysis, and reporting of findings based on quantitative and qualitative assessments of context. An overview of the CFIR will be presented. A quantitative measure, the Organizational Change Manager (OCM) was mapped to the CFIR. A case study implementation of family-centered care for poly-trauma patients will be used to demonstrate use of the OCM to guide and assess implementation and how findings can be organized using the broader CFIR framework, based on the mapping guidelines. Use of a common framework like the CFIR, can improve and accelerate interpretive synthesis of findings across settings and studies to better understand which implementation strategies work in which settings and why. Additionally, use of the CFIR can enhance critique of theoretical frameworks used in individual implementation studies.