Mental Health Integration in Geriatric Patient-Aligned Care Teams in the Department of Veterans Affairs

Abstract

Objectives: To inform geriatric mental health policy by describing the role of behavioral healthcare providers within a geriatric patient-aligned care team (GeriPACT), a patient-centered medical home model of care within the Veterans Health Administration (VHA), serving older veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges, and/or those who have elder abuse, risk of long-term care placement, or impending disability. Methods: The authors used mixed methods, consisting of a national survey and site visits between July 2016 and February 2017, at VHA outpatient clinics. The participants, 101 GeriPACTs at 44 sites, completed surveys, and 24 medical providers were interviewed. A standardized survey and semi-structured interview guide were developed based on the program handbook, with input from experts in the VHA Office of Geriatrics and Extended Care Services, guided by the Consolidated Framework for Implementation Science Research. Results: Of surveyed GeriPACTs, 42.6% had a mental health provider on the team-a psychiatrist (28.7%) and/or psychologist (23.8%). Of these, the mean was 0.27 full-time

A research proposal testing a new model of ambulation activity among long-term care residents with dementia/cognitive impairment: the study protocol of a prospective longitudinal natural history study

“…These PACTs enable earlier adoption of study findings—namely how behavioral information may be used to preserve the functional status of NH residents. In addition, the VA has expanded PACT to reach more specific populations; for example, the Geriatric Patient Aligned Care Teams, which provide health care for a subset of older Veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges [57]. Finally, there are about 133 VA NH’s in the United States that utilize this team and patient-centered approach to care and 39 of these facilities have some form of a RTLS (3 sites have the full RTLS implementation described here).…”

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

“…Most older clients will seek mental health services through their primary care provider (APA, 2008; Raue et al, 2017); therefore, psychologists who work in primary care settings may often receive referrals for older clients. Psychologists in geriatric primary care are responsible for providing behavioral health assessment and interventions to improve chronic disease management (Moye et al, 2019). In addition to depression and anxiety, primary care behavioral health referrals may involve concerns related to cognition, insomnia, pain, caregiving stress, bereavement, weight management, and risky consumption of alcohol, tobacco, and other substances (APA, 2008).…”

“…All psychologists who work with older adults, especially those working in medical settings, will benefit from possessing foundational knowledge of relevant medical and physical examinations, such as basic understanding of laboratory tests (e.g., vitamin B, vitamin D, folic acid, iron, sodium, and TSH levels), imaging studies (e.g., Head CT, Brain MRI), functional tests (e.g., cardiac stress test, pulmonary function test, six-minute walk, sleep study), and a brief neurological exam (Labott, 2019). Psychologists can then efficiently collaborate with other healthcare providers and specialists to clarify differential diagnosis, rule out reversible causes of cognitive and functional changes, and assist with longer term treatment planning (Moye et al, 2019). Whether an older client has an active infection or not, it is critical for psychologists to become familiar with institutional infection control procedures, namely standard and transmission-based precautions, such as handwashing, donning and doffing personal protective equipment, and contact isolation (Labott, 2019).…”

Improving Geropsychology Competencies of Veterans Affairs Psychologists

“…Integrated care, or systematic coordination of medical and mental health care using an interdisciplinary team‐based approach, currently shows the most promise in mental health outcomes for older patients 1,2 . Integrated care may offer better management of mental health issues and improve communication among interdisciplinary providers 3 . Although the incidence of mental health issues is lower in older adults, 20% experience clinically significant depression, anxiety, and stress, which can be exacerbated by physical health concerns and psychosocial stressors 4‐8 .…”

“…Despite evidence of older adults' need for geriatric mental health services and their preferred settings to seek mental health services, the need for geriatrics trained mental health providers far exceed the number of available providers 3,15,16 . Furthermore, although most practicing psychologists have a high likelihood of providing services to older populations, 4,17 the majority lack expertise in geriatrics and interprofessional competencies 18,19 .…”