A Learning Collaborative of CMHCs and CHCs to Support Integration of Behavioral Health and General Medical Care

Abstract

Even though numerous systemic barriers were encountered, the findings support existing literature indicating that the learning collaborative is a viable quality improvement approach for enhancing integration of general medical and mental health services between CHCs and CMHCs. Real-world implementation of evidence-based guidelines presents challenges often absent in research. Technical resources and support, a stable workforce with adequate training, and adequate opportunities for collaborator communications are particular challenges for integrating behavioral and general medical services across CHCs and CMHCs.

A Literature Review of Learning Collaboratives in Mental Health Care: Used but Untested

“…Very few details were provided on the techniques that were taught. In some studies, the LC purveyors had already identified potential areas for improvements that sites should consider for their QI projects (e.g., domains in the chronic care model, system improvements, known implementation barriers) (7, 18, 31, 33). In addition to didactic training related to practices and QI methods, four of the studies reported that individual sites presented information to other participating QI teams during the in-person sessions (7, 15, 27, 37).…”

“…However, there were a few studies that did provide some detail about the use of QI methods. In those LCs, the faculty set forth possible improvement areas from which site could develop their PDSAs or provided hands on coaching and support (7, 17, 18, 29–31, 34, 37, 38). One study, did not include PDSAs, but rather provided teams with a template to develop “work plans” to facilitate the integration of mental health and primary care in school based health centers (39).…”

“…Each of the ten articles that reported on provider-level variables reported positive trends from pre- to post-LC, suggesting improvements in areas such as process of care and uptake of new practices (17, 18, 28, 30–33, 37, 39). Similarly, although there were some mixed findings, each of the eleven articles reporting on patient-level variables reported positive pre- to post-LC changes in areas such as symptoms and engagement in services (15–17, 19, 28, 29, 35, 36).…”

“…Articles were excluded after the full-text review if they did not report any pre- to post-collaborative quantitative data. Following a review of those articles and their references, 20 articles were selected for final inclusion (see Figure 1 in online appendix) (15–18, 27–40). …”

“…The application of LCs in mental health has been to a wide range of practices—including process of care (e.g., engagement in services, care integration, use of a screener) (15–18) and implementation of complex evidence-based practice (7, 19). The focus on evidence-based practices is notable given the complexity of the patient outcomes and the substantial skill development required of providers.…”