Quality improvement processes resulted in the implementation and evaluation of 5 detection and treatment processes. Though varying by site, screening improved detection and a substantial number of patients received consultations and medication adjustments; however, symptom improvement was modest. (PsycINFO Database Record

Background Mental health and substance abuse are among the most commonly reported reasons for visits to Federally Qualified Health Centers (CHCs), yet only 6.5% of encounters are with on-site behavioral health specialists. Rural CHCs are significantly less likely to have on-site behavioral specialists than urban CHCs. Due to this lack of mental health specialists in rural areas, the most promising approach to improving mental health outcomes is to help rural primary care providers deliver evidence based practices (EBPs). Despite the scope of these problems, no research has developed an effective implementation strategy for facilitating the adoption of mental health EBPs for rural CHCs. Objectives To describe the conceptual components of an Implementation Partnership that focuses on the adaption and adoption of mental health EBPs by rural CHCs in Arkansas. Methods We present a conceptual model that integrates seven separate frameworks: 1) Jones and Wells’ Evidence-Based Community Partnership Model, 2) Kitson’s Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework, 3) Sackett’s definition of evidence-based medicine, 4) Glisson’s organizational social context model, 5) Rubenstein’s Evidence-Based Quality Improvement (EBQI) facilitation process, 6) Glasgow’s RE-AIM evaluation approach, and 7) Naylor’s concept of shared decision making. Conclusions By integrating these frameworks into a meaningful conceptual model, we hope to develop a successful Implementation Partnership between an academic health center and small rural CHCs to improve mental health outcomes. Findings from this Implementation Partnership should have relevance to hundreds of clinics and millions of patients, and could help promote the sustained adoption of EBPs across rural America.

Background Federally Qualified Health Centers (FQHCs) deliver care to 26 million Americans living in underserved areas, but few offer telemental health (TMH) services. The social missions of FQHCs and publicly funded state medical schools create a compelling argument for the development of TMH partnerships. In this paper, we share our experience and recommendations from launching TMH partnerships between 12 rural FQHCs and 3 state medical schools. Experience There was consensus that medical school TMH providers should practice as part of the FQHC team to promote integration, enhance quality and safety, and ensure financial sustainability. For TMH providers to practice and bill as FQHC providers, the following issues must be addressed: (1) credentialing and privileging the TMH providers at the FQHC, (2) expanding FQHC Scope of Project to include telepsychiatry, (3) remote access to medical records, (4) insurance credentialing/paneling, billing, and supplemental payments, (5) contracting with the medical school, and (6) indemnity coverage for TMH. Recommendations We make recommendations to both state medical schools and FQHCs about how to overcome existing barriers to TMH partnerships. We also make recommendations about changes to policy that would mitigate the impact of these barriers. Specifically, we make recommendations to the Centers for Medicare and Medicaid about insurance credentialing, facility fees, eligibility of TMH encounters for supplemental payments, and Medicare eligibility rules for TMH billing by FQHCs. We also make recommendations to the Health Resources and Services Administration about restrictions on adding telepsychiatry to the FQHCs’ Scope of Project and the eligibility of TMH providers for indemnity coverage under the Federal Tort Claims Act.