Partnership with theMental Health Product Line

Kathy L. Henderson, MDMichael R. Kauth, PhD

February 2011

South Central VA Health Care Network Mental Health Product Line

Organizational Chart

Deputy Manager

Administrative Officer

Integrated CareCoordinator

Administrative Support

Assistant

Network Homeless

Coordinator

Deputy Network Homeless

Coordinator

Administrative Support

Assistant

Network Suicide Prevention

Coordinator

Manager

Mental Health Product Line Advisory Council (MHPLAC)

• VISN 16 MHPLAC– Led by VISN 16 MHPL Manager– Composed of Key MH leaders from each facility– Chief of Staff, Social Work, Nurse Representatives– Medical Center Director Champion – Julie Catellier

(New Orleans)– MIRECC Representative—Associate Director for

Clinical Care (Pat Dubbert, PhD)– 18 Program Specific Workgroups

Mental Health Programs• Inpatient Psychiatry (Acute, Intermediate, STAR)

• Mental Health Residential Treatment Program (Doms, RRTPs)

• Ambulatory Mental Health• Mental Health Disaster Teams• Evidence-based

Psychotherapies• Psychosocial Rehabilitation

(CWT/SE, PRRCs)

• Primary Care MH• MHICM• Homeless Programs• Suicide Prevention• Telemental Health• MST• SUD• PTSD• MH OEF-OIF

MIRECC’s Role with the MHPLAC

• Works with all facilities and CBOCs• Addresses educational priorities/provides training

identified by facilities• Communicates with providers thru newsletter, COP,

individually• Engages CBOC providers in MIRECC mission• Assists with implementation of new clinical programs• Provides direction/consultation for clinical proposals and

educational grants• Voting member of MHPLAC

President’s New Freedom Commission

2003

VHA Comprehensive MH Strategic Plan

2004

Uniform MH Services Handbook

2008

T21 Implementation

2010

Zero Veteran Homelessness

Improve Veterans Mental Health

MH Enhancement InitiativeFTEE & Funding (FY05-FY10)

FTEE CO Funding2005 47.5 $3,399,7862006 121.55 $10,348,6592007 161.65 $16,158,3442008 66.0 $6,457,7262009 129.15 $12,691,4012010 33.5 $3, 567,573VISN 559.35 $52,623,489

90% fills thru September 2010

Growth in Mental Health Uniques (FY05-FY10)

ALX BIL FAV HOU JAC LIT MUS NOL OKL SHR V16-20.00

-10.00

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

-16.9

-1.6

16.0

6.7

-16.9

31.2

5.2

-16.0

6.8

-4.5-0.6

34.8

68.2 70.1

43.749.6

42.2

33.3

14.4

43.1

24.2

43.0

NonMH MH

Priorities for MHPL• Implement Uniform MH Services Handbook• Maintain mental health staffing enhancements• Increase access to specialty mental health services

in rural areas• Expand technology

– telemed, social networking, in home treatment• Review need for additional MH specialty/residential

beds• HOMELESS! HOMELESS! HOMELESS!

– Zero homelessness in 4 years

VISN 16 MH Clinical Education Priorities

Only undertake initiatives that are supported by the MHPLAC (often directly related to UMHS Handbook implementation)

MIRECC survey of 10 medical center MH programs and their CBOCs:

VAMC s                                                    CBOCs1. Brief SUD interventions                      1. Motivation interviewing, general2. DBT skills                                            2. Treating vets with PTSD and TBI3. Motivational interviewing, general      3. Suicide prevention4. SUD psychotherapy (CBT)                 4. Marital therapy/couples therapy5. Suicide prevention                              5. Brief SUD interventions

Update on Past Projects

1. UMHS DVDs to VISN 16 CBOCswww.mirecc.va.gov/VISN16/umhshs/umhshEducation.asp

2. CBT in VA medical center and community clinics: An implementation pilot – 3 published papers

Kauth, M.R., Sullivan, G., Cully, J., & Blevins, D. (in press). Facilitating practice changes in mental health clinics: A guide for implementation development in health care systems. Psychological Services.

Kauth, M.R., Sullivan, G., Blevins, D., Cully, J.A., Said, Q., Teasdale, T.A., & Landes, R.D. (2010). Employing external facilitation to implement cognitive behavioral therapy in VA clinics: A pilot study. Implementation Science, 5. www.implementationscience.com/content/5/1/75

 Cully, J.A., Teten, A.L., Benge, J., Sorocco, K.H., & Kauth, M.R. (2009). Multidisciplinary cognitive-behavioral therapy training for the VA primary care setting. Journal of Clinical Psychiatry: Primary Care Companion, 12(3), e1-e8.

Selected New Projects

Guide to VA Mental Health Services for Veterans & Familieswww.mirecc.va.gov/visn16/ and in hardcopy

For veterans to know what services areavailable where they live and to expect such services

Selected New Projects

Online Working with Couples Modules

Urgent clinical need by MHPLAC

– Two workshops + consultation in 2009 (Houston, Little Rock) for 58 MH clinicians (40% from CBOCs)

– MIRECC grant to produce 6 online modules + consultation in 2011; pilot with 80 MH clinicians

– Goal = increase training reach

Play clip

Selected New Projects

Promoting Telepsychotherapy

Urgent clinical need by MHPLCBOC Needs Assessment found TeleHealth system underused

– Team: Kauth, Greene (NCPTSD), Sorocco (OKC VA), Deen (LR VA), Smith (Wichita Falls CBOC)

– Pilot with 13 therapists who will provide EB psychotherapy to 7 clinics

– Assessment barriers and action to resolve + VTEL training with therapists + follow up

– Goal = reduce clinician anxiety; increase comfort; speed implementation

Selected New Projects

TBI Assessment Modules

Urgent clinical need by MHPLAC

– Basics of good TBI assessment– Goal = increase training reach

Play clip

Questions?