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VISN 2 Center for Integrated Healthcare (CIH)

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Mission

History

What is PCMHI?

Evidence on CCC

Mission of the Center for Integrated Healthcare

The VA Center for Integrated Healthcare (CIH) is a Center of Excellence located in VISN 2.The CIH mission is to improve the quality of Veterans health care by enhancing the integration of mental health services into primary care.The CIH Vision is to be a national resource regarding the integration of mental health in primary care.

Our mission flows directly from the requirement in VA's Uniform Mental Health Services Handbook that VA medical centers and community based outpatient clinics must provide integrated mental health services. Common themes across our work are highly aligned with Secretary’s Shulkin’s Top 5 priorities, including improving access to care and eliminating suicide. Our mission also supports the VA's Blueprint for Excellence in aligning with VA's national strategy to optimize population health outcomes and lead the field as an innovator in integrated health care.

To achieve our mission and vision, CIH team members engage in research, education, clinical and implementation initiatives to enhance the delivery of Primary Care-Mental Health services across the country. CIH is organized in research, education, and implementation cores that share the following common set of goals to ensure the team is working toward our a single purpose of advancing integrated care to improve the health of Veterans:

1. Advance the national implementation of integration

2. Develop and disseminate behavioral interventions that are feasible in primary care

3. Identity and disseminate best practices in integration

4. To train pre-doctoral students and post-doctoral fellows

History of the Center for Integrated Healthcare

On October 28, 2004, Department of Veterans Affairs Secretary Anthony Principi and Congressman James Walsh (R-NY 25th), announced that VA Health Care Upstate New York (VISN 2) would become the home of a special Center of Excellence devoted to advancing research, education, and clinical consultation to enhance the integration of mental health and primary care services for America's Veterans.

Located at the Syracuse VA Medical Center and at the VA Western New York Healthcare System at Buffalo along with virtual team members across the country, the Center for Integrated Healthcare (CIH) was created in response to the growing trend of integrating mental health prevention and treatment services into primary care clinics. The Center consists of a multidisciplinary team of researchers, educators, and implementation experts whose goal is to understand and improve VA's initiative to integrate mental health and primary care services.

Please use our website to learn more about who we are, what kind of research we do, what kind of educational activities we provide, and the clinical consultation services we offer.

What is Primary Care Mental Health Integration?

Integrated Primary Care Image

In the VA system, Integrated Primary Care is referred to as Primary Care-Mental Health Integration (PCMHI). PCMHI is a form of care where mental health and primary care providers work together to meet the health needs of their patients. In VA, these mental health providers are co-located in primary care and work closely with the members of the Patient Aligned Care Team (PACT), including the primary care provider. This team-based healthcare model allows the patient to have a more active role in his or her health care.

Integrated primary care has been found to improve the quality of care and patient satisfaction.

Integrated care programs help patients with all aspects of health and wellness. This includes prevention services, assessment, brief interventions, and referrals to more intense services when needed. The integrated mental health provider works with PACT members on the physical, behavioral, and emotional aspects of health care needs. Together the team works with the patient to develop a treatment plan. The plan can include ways to help with habits, behaviors, stress, or emotional concerns that get in the way of daily life and overall health. Integrated care can help with mild to moderate symptoms such as depression, anxiety, PTSD, substance misuse, family or relationship problems, grief, or anger.

Integrated care teams can help create a plan to quit smoking, lose weight, increase physical activity, or to make other improvements in health behaviors.

Integrated care teams can address issues such as chronic pain, sleep problems, high blood pressure, diabetes, asthma, or irritable bowel syndrome.

In general individual appointments with a mental health provider in primary care last 30 minutes or less. Patients are asked questions about physical symptoms, emotional concerns, health-related behaviors and how these might be related to one another. The goal is to come up with a plan for relieving symptoms and improving health.

Summary of Evidence on Co-located Collaborative Care

As further described within the paper, VA PCMHI programs include two components of collaborative care, Care Management (CM) and Co-located Collaborative Care (CCC). There are multiple published literature reviews focusing on the CM component, which focuses on care managers and collaborating providers with psychiatric prescription privileges supporting the delivery of mental health services delivered in primary care. The majority of this work has focused on improving the quality of pharmacotherapy. In comparison, there are no prior published comprehensive reviews of the literature regarding the provision of behavioral intervention services by licensed, independent practitioners (LIPs) embedded in primary care. Our aim was to address this gap, while focusing squarely in the key areas of CIH expertise.

It is our intent that this work will provide CIH, VHA practitioners, administrators, and other researchers with a thorough review of the literature and with a sound basis for future research and clinical innovations related to the role of MH LIPs embedded in primary care.

The topics covered in this white paper include:

  • A brief review of PCMHI in VA, including descriptions of CM and CCC for those who may be unfamiliar with how these terms are used in VA
  • Recommendations to advance the evidence-base on CCC
  • Three separate literature reviews focused on:
    • Patient and program level outcomes related to CCC
    • CCC behavioral health provider practice and fidelity in PCMHI
    • The evidence-base of brief behavioral interventions delivered in PCMHI

    There are multiple manuscripts either under review or nearing submission that have stemmed from this white paper.

    The website will be updated with these references as they become available.

    View the White Paper here.

Contact

Laura O. Wray, PhD
Executive Director
VA Medical Center, Buffalo, NY 14215
716-862-8598
laura.wray@va.gov

Stephen A. Maisto, PhD
Senior Consultant for Research and Leadership
VA Medical Center, Syracuse, NY 13210
315-425-4400 Ext. 54005
stephen.maisto@va.gov