MIRECC / CoE
Quality Improvement and Clinical Demonstration Projects | South Central MIRECC
Quality Improvement and Clinical Demonstration Programs
In the past 5 years, the Clinical Care portfolio has expanded both the depth and breadth of its interactions with partners. During this time, the SC MIRECC has provided leadership and resources to complete a series of regional and national demonstration projects. In addition, the Clinical Care Core engaged in a series of collaborative projects to address stakeholder needs related to the COVID-19 pandemic. For example, these collaborations included robust partnerships and consultations to enhance video delivery of mental health services (Dr. Jan Lindsay – program lead) and the development and implementation of a large-scale survey of VISN 16 & 17 mental health providers (n=1175) to better understand the impact of the pandemic on MH providers (Cully, et al., 2024 Psychological Services).
Current Project Examples
MyBrief CBT Program
In partnership with VA Health Systems Research and the Office of Rural Health, the MyBrief CBT program sought to implement and scale a brief evidence-based psychotherapy program for Veterans facing depression and suicidal ideation. The project sought to train and support providers with resources to enhance use of the MyBrief CBT program which was originally tested and shown to be effective using two VA multisite randomized trials. MyBrief CBT uses measurement-based care practices and includes a robust set of “practice-ready” resources that include provider and Veteran intervention materials, a flexible, modular online provider training program, posttraining provider support designed to enhance delivery of MyBrief CBT, an easy-to-use note template, and real-time data collection and sharing (available through a VA dashboard). Launched in FY21 in VISN 17 in partnership with OMHSP’s Center for Integrated Health, the program rapidly expanded to other VISNs. As of May 2024, over 200 providers across 14 VISNs and over 100 VA facilities are using the program. Collectively, these implementation and scaling efforts have led to over 1500 Veterans receiving the MyBrief CBT program with robust and positive clinical outcomes for depression improvement according to the Patient Health Questionnaire (PHQ-9).
Points of Contact: Dr. Jeffrey Cully and Mr. Darrell Zeno
Safe Gun Storage Kits
In partnership with VISN 16 Mental Health Program Office, the Alexandria VA Medical Center, national suicide prevention experts, and VA police officers - the SC MIRECC is helping to lead efforts to disseminate safe gun storage kits to Veterans. The current safe gun storage kit provides critical information about gun safety and gun storage options. In addition, these packets include physical gun storage items including VA issued gun locks and an empty chamber flag. Empty chamber flags, although not as secure as other means, offer Veterans another option for improving gun storage safety and reducing accidental discharge. Other recommendations for secure storage options are provided in the kit. As of 2024, over 2000 kits have been distributed through VA Community Engagement and Partnership Coordinators (CEPCs), Suicide Prevention Coordinators (SPCs), as well as through Vet Centers, Suicide Prevention Conferences, and through state-level initiatives. Kits are available upon request.
Points of Contact: Mr. Darrell Zeno and Dr. Jeffrey Cully
Past Project Examples
FLOW
The FLOW project developed processes to support the transition of stabilized or recovered specialty mental health patients back to primary care (PC). FLOW was conducted in partnership with VISNs 16 and 17 and has now been rolled out as a national program (10N Memo dated 9/12/2019). FLOW uses electronic-health-record-based criteria to identify Veterans receiving treatment in MH clinic settings who might be good candidates for transition to primary care. As an intervention, FLOW includes shared decision making during which MH providers and patients collaboratively determine whether primary care is the most appropriate setting for ongoing treatment. Data from the FLOW program showed that transitioning a stabilized/ recovered patient to PC can improve MH access without creating undue burden on PC providers. In addition to the adoption of FLOW as a national program, a SCMIRECC investigator (Dr. Natalie Hundt) is completing a QUERI project to better understand factors affecting FLOW implementation across six facilities in VISN 19.
Therametrics
TheraMetrics was designed to increase measurement-based care practices (MBC) in MH clinics by supporting providers in the use of VA’s Behavioral Health Lab (BHL). TheraMetrics was implemented at three sites in VISNs 16 and 17, was conducted over a 12-month period, and included preimplementation assessments, internal and external facilitation, provider BHL training, consultation with local champions, and program evaluation. Although the pandemic created barriers, TheraMetrics improved MBC practices across all sites with improvements in the number of MBC surveys administered (+9%-44%) and the number of Veterans receiving MBC care (+83%-171%). Facility champions played critical roles that complemented SCMIRECC efforts. TheraMetrics not only improved MBC practices but also exemplified the SCMIRECCs collaborative, stakeholder-informed approach, which strengthened our regional and local partnerships.
Administrative team contacts: Dr. Jeffrey Cully and Mr. Darrell Zeno
Administrative contacts
Jeffrey Cully, PhD, Associate Director for Improving Clinical Care; Jeffrey.Cully@va.gov
Darrell Zeno, MS, Senior Program Manager; Darrell.Zeno@va.gov
Last updated: June 28, 2024
