Literature Collection

The comprehensive health care integration (CHI) framework promotes the delivery of integrated physical and behavioral health care to adults and children in community settings by providing a flexible integration approach for both physical and behavioral health settings, including ongoing measurement of outcomes linked to payment methodologies. The CHI framework demonstrates value, strengthening alignment between provider organizations and payers to support service integration at implementation and on an ongoing basis.

BACKGROUND: Medication treatment for opioid use disorder is effective, and is recommended for adolescents, although very few adolescents with opioid use disorder ever receive medications. Reasons include lack of trained medication prescribers for this age group and difficulty in identifying adolescents with substance use disorders. This paper examines a novel implementation model of identifying and providing treatment for substance use disorders, including opioid use disorder, in a pediatric primary care practice. METHODS: Patients presenting to a selected primary care pediatrics practice for any reason between March 9, 2017, and July 24, 2017, who were identified by screening, self-report, or other clinical information to have a substance use problem were referred to an integrated clinical social worker for treatment. The authors recorded the number of patients who were referred, number of visits completed, and substance use disorder and mental health diagnoses. RESULTS: In the first 4 months of this program, 683 patients aged 12-22 completed a health maintenance appointment; 20 were referred for substance use disorder treatment and 13 completed at least 1 substance use disorder treatment visit with the integrated clinical social worker. The mean number of visits completed was 5.3. Three patients with opioid use disorders were identified, and 2 were induced on buprenorphine. CONCLUSIONS: The current model for treatment of substance use disorders, including opioid use disorders, was feasible and acceptable in a pediatric primary care practice. Broadly implemented, such a model could substantially increase access to substance use disorder treatment for adolescents and young adults.

BACKGROUND: Collaborative Care is a key strategy to improve population mental health by leveraging the expertise of psychiatric providers to support team-based treatment in primary care settings. Novel continuing education models can support psychiatric workforce development in this emerging area. OBJECTIVE: Describe the design, implementation, and outcomes of an interprofessional continuing education program for community-based psychiatrists and advanced practice psychiatric providers in practice across Washington State. METHODS: The part-time fellowship consists of the following four components: online didactics, live skills workshops, a quality improvement learning collaborative, and individual mentorship. The rationale and design of each component is described. Principles of adult learning were incorporated throughout, emphasizing active learning approaches. Evaluation included application data, fellows' attendance and session evaluations, and fellow surveys at baseline, end of fellowship, and 6 months postfellowship. Descriptive statistics and paired t-tests were used. RESULTS: In the first 5 years, 60 individuals graduated, with 72% from a designated mental health professional shortage area. They supported care delivered by 186 care managers and 696 primary care providers. Attendance was strong (79-90%) and fellows rated didactic quality and relevance highly (mean 4.5 out of 5 [standard deviation 0.30] and 4.5 [standard deviation 0.41], n = 1355 evaluations [85% response]). Relative to baseline, at graduation, fellows had significantly higher confidence in 49 of 53 clinical, systems-based, and quality improvement skills assessed (68-95% response); however, attitudes were unchanged (77-87% response). At baseline, 76% of fellows never reviewed aggregate patient data, whereas upon graduation, 48% did so at least quarterly (83% response). Graduates launched at least 8 new Collaborative Care programs in rural practices. CONCLUSIONS: The Community-based Integrated Care Fellowship exemplifies an innovative model that meets the lifelong learning needs of practicing psychiatric providers. Graduates increased their skills and embarked on practice change. Continuing education can be delivered through flexible, employment-friendly modalities at larger scale than traditional full-time clinical fellowships. This program demonstrates how active learning strategies can be utilized to stimulate clinical practice change. Moreover, its structure serves as a model for other psychiatric subspecialties, such as geriatrics or addictions, where workforce development targeting providers in practice may be particularly valuable.