Literature Collection

RATIONALE: Over 30% of adults in the United States have symptoms of depressive or anxiety disorders. The majority of these patients are treated only in primary care and have suboptimal outcomes. The Collaborative Care Model (CoCM) is designed to address this problem. AIMS AND OBJECTIVES: This study evaluated the implementation and effectiveness of CoCM at an urban academic medical center primary care clinic. METHODS: Retrospective chart review and analysis informed by the RE-AIM framework. RESULTS: Across 148 patients, mean PHQ-9 scores decreased by 4.8 (SD, 5.8, p < 0.001) and GAD-7 scores decreased by 5.6 (SD, 5.7, p < 0.001). Overall adoption rate was 36% and differed between attending physicians/APNs (50%) and residents (32%). Implementation showed fidelity to measurement-based care, but only 40% of cases were reviewed with the psychiatrist. CONCLUSION: A real-world CoCM can improve symptoms of depression and anxiety for adults; however, trainee adoption and adherence to psychiatric case reviews may merit special attention.

This paper introduces an evaluation of community-based, integrated health and social care multi-disciplinary teams (MDTs), primarily serving older people with long-term conditions, undertaken as part of the wider evaluation (2015-2022) of the Integrated Care and Support Pioneer Programme in England (2013-2018). To explain the context within which the MDT evaluation was undertaken, we first outline a brief history of health and social care integration policy in England, describe the Pioneer Programme and the requirements of the national 'longer-term' evaluation of the Pioneers. We then explain our rationale for focusing on MDTs, describe our conceptual framework of MDT functioning and provide a brief description of the evaluation design and methods, highlighting four overarching challenges we faced in undertaking it. We then briefly describe the individual papers that constitute the current supplement.

ObjectivesThis paper synthesises the findings of an evaluation of community-based multi-disciplinary teams (MDTs), primarily serving older people with long-term conditions, undertaken as part of a wider evaluation (2015-2022) of the Integrated Care and Support Pioneer Programme (2013-2018) in England. The MDT evaluation was undertaken in two contrasting Pioneers with 11 MDTs covering four models of MDT functioning.MethodsThe synthesis, set against our conceptual framework of MDT functioning, draws principally on the findings of semi-structured interviews with local strategic level health and care leaders, frontline MDT staff, and patients and their informal carers, observations of MDT meetings, and an online survey of MDT staff.ResultsMDTs were seen as an essential means of working towards local health and care integration. While local contexts shaped the precise aims, structure, composition and ways of working of the different MDT models studied, there were strong similarities across the teams in how staff viewed the nature and benefits of MDT working. MDTs were perceived as having the potential to provide more holistic care to patients, speed up access to care, improve access to a wider range of services and enhance care at home. Benefits to staff included better information sharing; reduced duplication of tasks; enhanced collective responsibility and problem-solving, which enriched decision-making; opportunities to learn from, and about, the remits of other professional groups and services; and the erosion of traditional professional hierarchies. However, barriers to MDT working, including the absence of shared patient records, inadequate infrastructure and resources, and concerns about the ability to measure and demonstrate the value of MDT working, were also identified. Patients and their informal carers reported valuing good communication with their health and care providers but often appeared unaware of an MDT's involvement in planning their care. This suggests there is some distance to travel in terms of how MDTs communicate their roles to those they serve.ConclusionsAt the service delivery level, our findings' implications for policy and practice include the need for greater integration across patient records and data systems, and greater investment in specialist services (e.g., housing) currently absent from MDTs. However, our research also highlighted challenges to evaluating the outcomes of 'integration' both as a concept and at the service delivery level. Changes to both the research environment and the approach to evaluation are also warranted.

BACKGROUND: Trauma-informed care (TIC) is a framework designed to understand and address the impacts of trauma, ensuring physical, psychological, and emotional safety for all involved. It seeks to prevent retraumatization and promote a sense of control and empowerment across diverse populations. METHOD: This Trauma Prevention Coalition survey study assessed TIC implementation among members from 13 of the 16 participating organizations, focusing on prevalence, awareness, and training gaps. RESULTS: Out of 948 participants, 91% (n = 861) were affiliated with trauma centers. In adult trauma centers: 19.3% were from Level I, 9.4% from Level II, 5.4% from Level III, 3.1% from Level IV, and 1.2% from Level V. In addition, 1.2% were from nonadult trauma centers, and 2.5% worked in centers serving both adult and pediatric patients. In pediatric centers: 18.6% were from Level I, 13.0% from Level II, 1% from Level III, and 67.0% from nonpediatric centers. Trauma-informed care principles were integrated into the core values of 35.5% of trauma centers, while 64.5% had not adopted them. Only 17.0% had TIC training plans, with 57.7% lacking or unaware of such plans. Bivariate regression analysis indicated that TIC integration decreased for Level II, Level IV, and nontrauma centers compared with Level I adult trauma centers, but increased for Level III. In pediatric centers, TIC integration decreased for Level II, Level III, Level IV, and nontrauma centers compared with Level I. Pediatric trauma centers showed a higher TIC integration rate (71.6%) compared with adult centers (39.4%, p < 0.01). CONCLUSION: TIC adoption varies significantly across trauma center levels, with higher prevalence in pediatric and Level I centers. The study underscores the need for comprehensive TIC training within trauma care systems. LEVEL OF EVIDENCE: Therapeutic/care management; Level IV.

BACKGROUND: Since 2006, the Australian government has expanded access to primary mental healthcare for youth aged 12-25 years through the headspace platform. However, structural barriers exist in the integration of headspace centres with local state-funded specialised mental health services. The aim of this study was to translate an emerging service integration framework (Youth Integration Project (YIP)) into a tool to determine levels of integration between headspace and local specialist services/programme and identify areas for improving service integration. METHOD: The Rating of Integrated Health Services (RIHS) survey was developed based on the YIP framework to assess levels of youth mental health service integration in New South Wales (NSW) local health districts (LHDs). Managers of specialist services/programmes across 18 LHDs in NSW were invited to complete the RIHS survey. Responses were coded into indicators of levels of integrated care and aggregated into an overall assessment of service integration. RESULTS: Validity of the RIHS scales was indicated by positive correlations with independent items of service integration. In relation to integration levels, 41/56 services/programmes had minimal-to-basic levels of integration with headspace centres. The results were consistent across programmes and regions. Three structural areas of interagency collaboration were identified for improving service integration: (i) information systems, communication, products and technology; (ii) financing; and (iii) leadership, governance, policy and values. CONCLUSIONS: The results provide evidence of the significantly fragmented youth mental healthcare system in Australia. There is a need to address structural aspects of service integration to improve integration between headspace and LHD services for young people.