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Collaborative Care

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Dynamic Diffusion

Learning Collaborative

This video is intended for use by VA staff who wish to introduce Veterans and/or other staff to moral injury groups. The Veterans in this video are real people who participated in a moral injury group facilitated by a psychiatrist and a chaplain in Nashville, TN. The group focused on male Veterans with combat-related moral injury, though moral injury encompasses a diverse array of experiences and can affect any Veteran. For more information, visit the VA Diffusion Marketplace website.

What is the Dynamic Diffusion Network?

A network of IMH-trained chaplains* and mental health partners who have been identified as leaders in the areas of suicide prevention and moral injury based on approaches they have developed to address these complex problems.

What is “dynamic diffusion”?

An innovative approach to development and dissemination. Care practices are delivered and continuously evaluated under real-world conditions as part of a structured network experience that promotes cross-pollination of ideas and shared learning to generate relatively rapid improvements in care.

*Integrative Mental Health offers a recurring, intensive Mental Health Integration for Chaplain Services (MHICS) training. Chaplains in the Dynamic Diffusion Network have completed MHICS and/or the IMH Learning Collaborative (see tab above).

Participating Sites


Practice Descriptions

For more information about these practices, contact Integrative Mental Health at




Building on recommendations from the VA/DoD Integrated Mental Health Strategy, VA and DoD conducted a "learning collaborative" that brought together teams from 14 medical centers across the country to focus on better integrating mental health and chaplain services at their respective sites. Teams utilized the learning collaborative methodology to employ systems redesign principles to improve their clinical care. In the case of Mental Health and Chaplaincy Learning Collaborative, this entailed improving: mutual awareness between mental health and chaplaincy; practices for communicating and coordinating care; and formalized methods for integration. The three videos below describe the learning collaborative rationale, process, and findings; highlighting practical experiences from successful participating teams.


Learning Collaborative - Establishing Awareness - Video #1

Learning Collaborative - Communicating and Coordinating Care - Video #2

Learning Collaborative - Formalizing Systematic Processes - Video #3 

Model for Integration

    Teams were guided by the below model to help them focus on better integrating care across six domains: screening and referrals (i.e., patient flow practices); communication, documentation, and assessment (i.e., professional practices); and role clarification and cross-disciplinary training (i.e., interdisciplinary relationships). Teams came together on three separate occasions over the course of a year to focus on different points of the model (first patient flow, then professional practices, then interdisciplinary relationships), sharing system improvement approaches and metrics with one another along the way.



    Specifically, the six aims of the learning collaborative are to strengthen and improve:

    1. Screening - Evaluate current practices for screening patients for spiritual and mental health issues, with the intention of strengthening existing practices and/or implementing new research-informed screening practices where none exist.
    2. Referrals - Strengthen and/or develop clearly articulated processes for referring patients between disciplines, including processes to contact the other discipline, communicate the core issue, articulate a basic care plan, and conduct follow up.
    3. Assessment - Develop, improve, and/or ensure standardized use of multidimensional spiritual and mental health assessments that can contribute to making effective referrals and to providing relevant healthcare information to the other discipline.
    4. Communication and Documentation - Establish regular communication practices, ideally as part of recurring integrated care team meetings, and document care and consults in a useful manner to the other discipline (at facilities where chaplain documentation of care is expected).
    5. Cross-Disciplinary Training - Champion cross-disciplinary training opportunities, at a minimum to inform colleagues about the aims of and rationale for this learning collaborative.
    6. Role Clarification - Develop a better understanding of chaplain and mental health provider roles, culminating in the development of formal documentation of how mental health and chaplain services collaborate (e.g., care coordination agreement).

    The overall objectives of the learning collaborative were to:

    • Learn about and share strong practices at participating sites for effectively integrating chaplaincy into PTSD and mental health care services.
    • Teach quality improvement techniques to teams of mental health professionals and chaplains
    • Establish participating facilities as resources for other sites seeking to better integrate mental health and chaplain services.
    The Integrative Mental Health Program partnered with the Defense Centers of Excellence, the VA Center for Applied Systems Engineering (VA-CASE), and the Durham Health Services Research and Development Center of Innovation (HSR&D) to conduct this learning collaborative. Participating sites are listed below.
    DoD VA
    Air Force: Joint Base San Antonio Cheyenne VA Medical Center
    Army: Fort Belvoir James A. Haley Veterans' Hospital - Tampa, Florida
    Army: Pacific Regional Medical Center, Tripler Louis Stokes Cleveland VA Medical Center
    Army: Southern Regional Medical Command San Antonio Richard L. Roudebusch VAMC Indianapolis, IN
    Navy: Naval Hospital Camp Lejeune South Texas Veterans Health Care System, San Antonio
    Navy: Naval Hospital Pensacola VA North Texas Health Care System, Dallas
    Navy: Naval Medical Center San Diego VA Pittsburgh Healthcare System