Veterans Engaged in Treatment, Skills, and Transitions for Enhancing Psychiatric Safety (VETSTEPS).

Abstract

Objective:The transition after inpatient psychiatric care is a critical time with increased risk. This brief report evaluates Veterans Engaged in Treatment, Skills, and Transitions for Enhancing Psychiatric Safety (VETSTEPS), a program designed for this critical time. Method: Three "bridging" strategies were employed: (a) using inpatient-outpatient care collaboration; (b) four phone calls within seven days of discharge; and (c) a 4-week, evidence-based intervention that provided safety planning, coping skills, and triage services for postdischarge needs. Using retrospective data from 219 military veterans, VETSTEPS impact on treatment follow-up rates and veteran readmissions was examined. Results: Group participation was associated with significantly sooner mental health follow-up access, for both first and second follow-up appointments. Greater group participation was associated with lower rates of 12-month readmission, with more attended sessions associated with fewer readmissions when controlling for length of stay and previous readmissions. Following a hospital-wide strategy to implement VETSTEPS team phone calls, exploratory analyses indicate the facility's mental health care follow-up rate significantly improved from 55% to 79%, with sustained gains above 80% for two years. Conclusions and Implications for Practice: Program evaluation data suggest that bridging critical time interventions may improve outcomes for veterans recently discharged from psychiatric hospitalization. Impact and ImplicationsThis study offers some preliminary yet promising news for clinicians serving veterans recently discharged from a psychiatric hospitalization. Innovative "bridging" programs where veterans receive critical time intervention utilizing inpatient-outpatient care collaboration can improve continuity of care. Additionally, efficient modalities such as telephone calls and therapeutic groups can be effective ways to mitigate risk during this critical time. Safety planning and skills-based group treatment may serve to provide needed psychoeducation and support among this high-risk demographic. Lastly, although 7-day postdischarge appointments are a critical first step, continued access to care beyond the first week of discharge may be particularly important in reducing hospital readmission.

Characterization of multilevel influences of mental health care transitions: a comparative case study analysis

“…For integration of multiple services within and across sectors , challenges include continued practice of traditional (i.e., less recovery-focused) care [ 96 ] and inconsistent information transfer between settings [ 98 ]. Transition programs that focus on recovery are being tested and used [ 99 , 100 ], and VA has endorsed an organization-wide change of mental health care to more explicitly reflect recovery values [ 93 ]. Furthermore, with regard to recovery-oriented services, each of Freedom Commission’s recommendations, SAMHSA’s framework, and policy directives on such services urges the need for transitions that specifically support recovery [ 101 ].…”

Bridging the Acute-to-Outpatient Care Gap in Mental Health

“…In developing and adjusting this effort, we drew both from the QUERI framework for improving transitional care and from other quality improvement literature focused on transitions of MH care. 9,10,17 A unifying theme in the literature was bridging contact pre-and postdischarge, which was a major strength of our program. As seen in prior transitions-of-care efforts, our program involved a multidisciplinary approach with the involvement of multiple stakeholders in development of the process.…”

“…Efforts to address transitions of care require engaging multiple stakeholders across various settings with interdisciplinary collaboration, building out or adjusting processes on the acute side and the outpatient setting, and developing bridging interventions 3,9–11. The effort described here included a combination of strategies that previously have been found to be successful in improving transition processes.…”

Understanding suicide: Development and pilot evaluation of a single-session inpatient psychoeducation group.

“…To our knowledge, no published study has reported on suicide-specific group-based programming for veterans hospitalized for a suicide-related concern (Spears et al, 2019). Suicide-specific groups delivered on an outpatient basis appear to be acceptable and potentially efficacious for general samples (Hom et al, 2018) as well as veterans (Johnson et al, 2014, 2019; Wray et al, 2019). Notably, Johnson et al (2014) described attempting to incorporate current psychiatric inpatients into their process-oriented suicide-focused outpatient group for veterans recently discharged from inpatient psychiatry, but encountered logistical challenges (e.g., getting the inpatients to the outpatient location for the group) that rendered this option unsustainable.…”