Improving medical residents’ utilisation of integrated mental health in primary care

BackgroundIntegration of mental health services allows for improved prevention and management of chronic conditions within the primary care setting. This quality improvement project aimed to increase adherence to and functioning of an integrated care model within a patient-centred medical home. Specifically, the project focused on improving collaboration between Primary Care Mental Health Integration (PC-MHI) and the medical resident Patient Aligned Care Teams (PACT) at a Veterans Affairs Medical Center in Northport,New York (VAMC Northport).MethodThe project used increased education, training and relationship building among the medical resident PACTs, and the establishment of regularly occurring integrated team meetings for medical and mental health providers. Education of residents was measured with a self-assessment pre-training and post-training, while utilisation was measured by the percentage of patients currently on a PACT’s panel with at least one PC-MHI encounter in the last 12 months (known in VAMC Northport as PACT-15 metric).ResultsTwo resident PACTs that received both training and weekly integrated meetings increased their utilisation of integrated mental health services by 3.8% and 4.5%, respectively. PACTs that participated in training only, with no regular meetings, showed an initial improvement in utilisation that declined over time.ConclusionsTraining alone appeared beneficial but insufficient for increased integration over time. The addition of a regularly occurring integrated weekly meeting may be a critical component of facilitating sustained mental health integration in a primary care medical home model.

A Roadmap to Inform the Implementation of Evidence-Based Collaborative Care Interventions in Communities: Insights From the Michigan Mental Health Integration Partnership

Background: Despite increasing calls for further spread of evidence-based collaborative care interventions (EBIs) in community-based settings, practitioner-driven efforts are often stymied by a lack of experience in addressing barriers to community-based implementation, especially for those not familiar with implementation science. The Michigan Mental Health Integration Partnership (MIP) is a statewide initiative that funds projects that support implementation and uptake of EBIs in community-based settings. MIP also provides an in situ implementation laboratory for understanding barriers to the uptake of EBIs across a variety of settings. We report findings from a statewide qualitative study of practitioners involved in MIP projects to garner their perspectives of best practices in the implementation of EBIs.Methods: Twenty-eight semi-structured interviews of practitioners and researchers from six MIP Projects were conducted with individuals implementing various MIP EBI projects across Michigan, including stakeholders from project teams, implementation sites, and the State of Michigan, to identify common barriers, challenges, and implementation strategies deployed by the project teams, with the purpose of informing a set of implementation steps and milestones.Results: Stakeholders identified a number of barriers to and strategies for success, including the need for tailoring program deployment and implementation to specific site needs, development of web-based tools for facilitating program implementation, and the importance of upper-level administration buy-in. Findings informed our resultant community-based Implementation Roadmap, which identifies critical steps across three implementation phases—pre-implementation, implementation, and sustainability—for implementation practitioners to use in their EBI implementation efforts.Conclusion: Implementation practitioners interested in community-based EBI implementation often lack access to operationalized implementation “steps” or “best practices” that can facilitate successful uptake and evaluation. Our community-informed MIP Implementation Roadmap, offering generalized steps for reaching successful implementation, uses experiences from a diverse set of MIP teams to guide practitioners through the practices necessary for scaling up EBIs in community-based settings over pre-implementation, implementation and sustainability phases.

An Interview With Chief Årestad-Radner of the Swedish Police Authority

In this interview, Chief Årestad-Radner, National Coordinator of Recruitment for the Swedish Police Authority, provides her unique insights into law enforcement in Sweden. She discusses her experiences within the police agency and the changes in which she has been involved throughout her career. She describes the current training procedures, the strengths of these, and areas of growth. She reflects on the unique challenges of policing in Sweden, identifying possible solutions to overcome these challenges. Chief Årestad-Radner discusses the need for a police force that is representative of the community as well as the need for a standardized system for recruiting for higher-level positions. In addition, she describes the need for mental health integration within the police department and discusses the benefit of doing so. Lastly, she identifies the need for further research within law enforcement.

An Interview With Dr. Gardner, Police Psychologist Oakland County Sheriff's Office, MI

In this interview, Dr. Gardner, Police Psychologist of the Oakland County Sheriff's Office, provides his insights about working with police officers. He provides an overview of the factors that influenced his decision to pursue this career and which experiences were the most meaningful in helping him be successful as a provider within this unique population. He describes his qualifications as a psychologist, his experiences as a police officer, and the importance of having both of these. He discusses the differences in culture between police officers and the community and the barrier this creates for non-police psychologists to serve such individuals. In addition, he reflects on the unhelpful aspects of cop culture and the negative effects this has on officers' mental health. For the sake of increasing mental health integration and improving officers' quality of life, he concludes by encouraging more individuals to pursue a career in police psychology.

An Interview With Chief Johnson of the East Lansing, MI Police Department

In this interview, Chief Johnson of the East Lansing Police Department, describes his journey of becoming the Chief of Police in East Lansing, MI. He discusses how his interests in law enforcement began and reflects on the changes observed within the police department and within the community over the last three decades. He provides insight into current police training procedures, the benefits of these in preparing new officers, and areas for improvement. In addition, Chief Johnson discusses his vision for the development of the police department, including the expansion of police training and the need for mental health integration to increase effectiveness. He observes the need for continued research in law enforcement to aid in the development of this field.

A Roadmap to Inform the Implementation of Evidence-Based Collaborative Care Interventions in Communities: Insights From the Michigan Mental Health Integration Partnership

BackgroundIn spite of increasing calls for further spread of evidence-based collaborative care interventions (EBIs) in community-based settings, practitioner-driven efforts are often stymied by a lack of experience in addressing barriers to community-based implementation, especially for those not familiar with implementation science. The Michigan Mental Health Integration Partnership (MIP) is a statewide initiative that funds projects that support implementation and uptake of EBIs in community-based settings. MIP also provides an in situ implementation laboratory for understanding barriers to the uptake of EBIs across a variety of settings. We report findings from a Statewide qualitative study of practitioners involved in MIP projects to garner their perspectives of best practices in the implementation of EBIs. MethodsTwenty-eight semi-structured interviews of practitioners and researchers from six MIP Projects were conducted with individuals implementing various MIP EBI projects across Michigan, including stakeholders from project teams, implementation sites, and the State of Michigan, to identify common barriers, challenges, and implementation strategies deployed by the project teams, with the purpose of informing a set of implementation steps and milestones. ResultsStakeholders identified a number of barriers to and strategies for success, including the need for tailoring program deployment and implementation to specific site needs, development of web-based tools for facilitating program implementation, and the importance of upper level administration buy-in. Findings informed our resultant community-based Implementation Roadmap, which identifies critical steps across three implementation phases--pre-implementation, implementation, and sustainability—for implementation practitioners to use in their EBI implementation efforts. ConclusionImplementation practitioners interested in community-based EBI implementation often lack access to operationalized implementation “steps” or “best practices” that can facilitate successful uptake and evaluation. Our community-informed MIP Implementation Roadmap, offering generalized steps for reaching successful implementation, uses experiences from a diverse set of MIP teams to guide practitioners through the practices necessary for scaling up EBIs in community-based settings over pre-implementation, implementation and sustainability phases.