Provision of integrated care arrangements for the diabetic foot has a positive impact on primary care staffs' knowledge and patients' attitudes resulting in an increased number of appropriate referrals to acute specialist services.

Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders. First, we review foundational HIT research on how EBHIS can enhance efficiency and outcomes of wraparound that was used to inform development. After describing the rationale for and functions of a prototype EBHIS for wraparound, we describe methods and results for a series of six small studies that informed system development across four phases of effort -predevelopment, development, initial user testing, and commercialization -and discuss how these results informed system design and refinement. Finally, we present next steps, challenges to dissemination, and guidance for others aiming to develop specialized behavioral health HIT. The research team's experiences reinforce the opportunity presented by EBHIS to improve care coordination for populations with complex needs, while also pointing to a litany of barriers and challenges to be overcome to implement such technologies.Among the approximately 15 million young people with mental health conditions, children and adolescents with serious emotional and behavioral disorders (SEBD) are at the greatest risk for negative health and functioning outcomes, including school dropout, drug and alcohol abuse, incarceration, and unemployment (Perou et al., 2013). These youth also consume a disproportionate share of the nation's overall children's mental health care resource. Of $10 billion expended annually by Medicaid on mental health services for Correspondence regarding this submission should be addressed to Eric J. Bruns, University of Washington, Department of Psychiatry and Behavioral Sciences, 2815 Eastlake Ave E, Suite 200, Seattle, WA, 98102; ebruns@uw.edu.. HHS Public Access Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript children and adolescents, $6 billion goes to treating the 10% of youth with the most serious and complex needs (Pires, Grimes, Allen, Gilmer, & Mahadevan, 2013). A large proportion of these expenses are accounted for by inpatient, residential, and other out-of-home treatment options that may be unnecessary when effective and intensive service options are available in the community (Cooper et al., 2008;Stroul & Friedman, 1996) Tolan & Dodge, 2005) As early as 2003, the Institute of Medicine formally recognized care coordination as a priority area for quality improvement in health care (Institu...

BackgroundElectronic health records (EHRs) have been widely proposed as a mechanism for improving health care quality. However, rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents.ObjectiveThe current study evaluated the usability of an EHR developed to support the implementation of the Wraparound care coordination model for children and youth with complex behavioral health needs, and impact of the EHR on service processes, fidelity, and proximal outcomes.MethodsThirty-four Wraparound facilitators working in two programs in two states were randomized to either use the new EHR (19/34, 56%) or to continue to implement Wraparound services as usual (SAU) using paper-based documentation (15/34, 44%). Key functions of the EHR included standard fields such as youth and family information, diagnoses, assessment data, and progress notes. In addition, there was the maintenance of a coordinated plan of care, progress measurement on strategies and services, communication among team members, and reporting on services, expenditures, and outcomes. All children and youth referred to services for eight months (N=211) were eligible for the study. After excluding those who were ineligible (69/211, 33%) and who declined to participate (59/211, 28%), a total of 83/211 (39%) children and youth were enrolled in the study with 49/211 (23%) in the EHR condition and 34/211 (16%) in the SAU condition. Facilitators serving these youth and families and their supervisors completed measures of EHR usability and appropriateness, supervision processes and activities, work satisfaction, and use of and attitudes toward standardized assessments. Data from facilitators were collected by web survey and, where necessary, by phone interviews. Parents and caregivers completed measures via phone interviews. Related to fidelity and quality of behavioral health care, including Wraparound team climate, working alliance with providers, fidelity to the Wraparound model, and satisfaction with services.ResultsEHR-assigned facilitators from both sites demonstrated the robust use of the system. Facilitators in the EHR group reported spending significantly more time reviewing client progress (P=.03) in supervision, and less time overall sending reminders to youth/families (P=.04). A trend toward less time on administrative tasks (P=.098) in supervision was also found. Facilitators in both groups reported significantly increased use of measurement-based care strategies overall, which may reflect cross-group contamination (given that randomization of staff to the EHR occurred within agencies and supervisors supervised both types of staff). Although not significant at P<.05, there was a trend (P=.10) toward caregivers in the EHR group reporting poorer shared agreement on tasks on the measure of working alliance with providers. No other significant between-group differences were found.ConclusionsResults support the proposal that use of EHR systems can promote the use of client progress ...

Table of contentsIntroduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnershipsCara Lewis, Doyanne Darnell, Suzanne Kerns, Maria Monroe-DeVita, Sara J. Landes, Aaron R. Lyon, Cameo Stanick, Shannon Dorsey, Jill Locke, Brigid Marriott, Ajeng Puspitasari, Caitlin Dorsey, Karin Hendricks, Andria Pierson, Phil Fizur, Katherine A. ComtoisA1: A behavioral economic perspective on adoption, implementation, and sustainment of evidence-based interventionsLawrence A. PalinkasA2: Towards making scale up of evidence-based practices in child welfare systems more efficient and affordablePatricia ChamberlainA3: Mixed method examination of strategic leadership for evidence-based practice implementationGregory A. Aarons, Amy E. Green, Mark. G. Ehrhart, Elise M. Trott, Cathleen E. WillgingA4: Implementing practice change in Federally Qualified Health Centers: Learning from leaders’ experiencesMaria E. Fernandez, Nicholas H. Woolf, Shuting (Lily) Liang, Natalia I. Heredia, Michelle Kegler, Betsy Risendal, Andrea Dwyer, Vicki Young, Dayna Campbell, Michelle Carvalho, Yvonne Kellar-GuentherA3: Mixed method examination of strategic leadership for evidence-based practice implementationGregory A. Aarons, Amy E. Green, Mark. G. Ehrhart, Elise M. Trott, Cathleen E. WillgingA4: Implementing practice change in Federally Qualified Health Centers: Learning from leaders’ experiencesMaria E. Fernandez, Nicholas H. Woolf, Shuting (Lily) Liang, Natalia I. Heredia, Michelle Kegler, Betsy Risendal, Andrea Dwyer, Vicki Young, Dayna Campbell, Michelle Carvalho, Yvonne Kellar-GuentherA5: Efficient synthesis: Using qualitative comparative analysis and the Consolidated Framework for Implementation Research across diverse studiesLaura J. Damschroder, Julie C. LoweryA6: Establishing a veterans engagement group to empower patients and inform Veterans Affairs (VA) health services researchSarah S. Ono, Kathleen F. Carlson, Erika K. Cottrell, Maya E. O’Neil, Travis L. LovejoyA7: Building patient-practitioner partnerships in community oncology settings to implement behavioral interventions for anxious and depressed cancer survivorsJoanna J. Arch, Jill L. MitchellA8: Tailoring a Cognitive Behavioral Therapy implementation protocol using mixed methods, conjoint analysis, and implementation teamsCara C. Lewis, Brigid R. Marriott, Kelli ScottA9: Wraparound Structured Assessment and Review (WrapSTAR): An efficient, yet comprehensive approach to Wraparound implementation evaluationJennifer Schurer Coldiron, Eric J. Bruns, Alyssa N. HookA10: Improving the efficiency of standardized patient assessment of clinician fidelity: A comparison of automated actor-based and manual clinician-based ratingsBenjamin C. Graham, Katelin JordanA11: Measuring fidelity on the cheapRochelle F. Hanson, Angela Moreland, Benjamin E. Saunders, Heidi S. ResnickA12: Leveraging routine clinical materials to assess fidelity to an evidence-based psychotherapyShannon Wiltsey Sti...