Update on South Central Mental Illness Research, Education - PowerPoint Presentation

Update on South Central Mental Illness Research, Education & Clinical Center (SC MIRECC) Greer Sullivan, MD, MSPHFebruary 2011

South Central MIRECC 2011 Advisory Board MeetingVISN 16South Central MIRECCAchievements and challengesQuestions for the 2011 Advisory BoardOverview of today’s presentations

Veterans Integrated Service Network (VISN) 16170,000 square miles8 states (AR, LA, TX, MS, OK, FL, MO, AL)16 Senators30 Congressional districts10 VA Medical Centers50+ CBOCs$6.6 billion annual budget

Gulfport New Orleans August 28, 2005

VISN 16 Veterans1.9 million eligible veterans450,000+ served annuallyDistinctive characteristicsethnically diverse51% ruralless educated, poorersicker: mental and physical healthlarge geriatric population greatest number of OEF-OIF veterans

VISN 16 Mental HealthAbout 25% of veterans who use VA services receive mental health care (roughly 120,000)Approximately 2000 mental health providersVISN 16 mental health product line: Manager: Kathy Henderson, MD Product Line Advisory Council (PLAC) Monthly PLAC teleconference

VISN 16 Research CentersSouth Central MIRECCHouston HSR&D programLittle Rock HSR&D programGRECC (Little Rock)TBI Research Center (Houston)Mental Health QUERI (Little Rock)Substance Use Disorder QUERI (Houston)

South Central MIRECCFunded: 1998Adopted rural theme: 2008MissionTo improve access to evidence-based practices in rural and other underserved populations, especially vulnerable elderly veterans, veterans affected by natural disasters, and returning veterans.

n SC MIRECC is a virtual VISN-wide center with 4 anchor sites. Little Rock Houston Oklahoma City New Orleans

SC MIRECC Organizational Chart SCVAHCN Mental Health Product Line VISN Consumer Advisory Board South Central VA Health Care Network (SCVAHCN) VHA Office of Mental Health Services DIRECTOR CO-DIRECTOR National Advisory Board RESEARCH TRAINING CORE (Kunik) CLINICAL CARE CORE (Dubbert) RESEARCH CORE (Fortney) EDUCATION CORE (Kauth) Research Methods Consultation: MIDAS Fellowship Program Grant Writing Scholars Research / Pilot Studies Clinical Educator Grants Communication Clinician Training TRIPS Program MIRECC LEADERSHIP COUNCIL Consultation to VISN 16 Product Line Assistance with Implementation Site Leaders

Anchor Site LeadersHouston – Melinda Stanley, PhDLittle Rock – Jeff Pyne, MDNew Orleans – Joseph Constans, PhDOklahoma City – Tom Teasdale, DrPHAdministrative Support Houston – Brenda Schubert, Mathilda CeaserLittle Rock – Kristin Ward, Melonie Shelton New Orleans – Kerri Faircloth Oklahoma City – Linda Muse Recruiting budget specialist

Advice of 2009 Advisory BoardDefine “big picture” issues for centerBecome known as rural centerFocus on rural minoritiesUtilize technology in education and researchDevelop outreach to communities and CBOC’sEmphasize implementationPromote large scale, MIRECC-wide research

Lay Out “Big Picture” Issues100% 100% 100% Need mental health care Enter mental health care Receive high quality mental health care 100% 30% 10% *Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627.

Rural residents are more likely to: Receive no mental health careSeek care from informal “providers”Receive mental health care from PCPsReceive poorer quality careReceive medications only Have smaller social networks and remain longer in networks Be skeptical about mental health treatment effectiveness Be concerned about anonymity and stigma Value independence and stoicism

100%30% 10% ENGAGEMENT AND ACCESS GAP QUALITY OF CARE GAP CBOC’s Take treatment to patient Community engagement Evidence-based treatment Tailoring treatment Reorganize care

Become better known as a rural center and leader in rural mental health.National Rural Health AssociationJournal of Rural HealthTexas A&M School of Rural Public HealthVA State of the Art (SOTA) conference, “Improving Access to Care” Rural Mental Health Contracting PilotBuilding relationships with VA Rural Centers (Salt Lake City, Iowa City)

Emphasize research on rural minority populations. Recruited two new African-American investigatorsRecruited three African-American fellowsStarting a racial disparities interest group

Get on the technology bandwagon! CBOC Partnership Program evolved into Community of Practice professional networking siteDevelopment of on-line provider trainingTechnology research applications - V-Tel - Measurement-based tracking - CBT by phone - Smart phone apps - Virtual reality - Remote monitoring devices - Computer assisted CBT

Build outreach to communities using community based participatory research (CBPR) approaches. ACCESS: rural “early responders” program - Clergy, court system, community collegesCommunity college outreach Education of community based, non-VA PCP’s

Promote and evaluate implementation.

Undertake larger VISN-wide research projects.Documented collaboration across MIRECC sitesSponsored two “mini-retreats” to plan MIRECC-wide projects; one resulted in HSR&D applicationInitiated two MIRECC-wide “working groups” (Technology, CBT) Started two HRS&D-funded VISN–wide projects (Fortney, Sullivan)

Challenges“Administrating” across four sitesIncreasing administrative constraintsBalancing service to many mastersRecruiting Using resources optimally Documenting our value, impact, and productivity

Questions for BoardHow are we doing in terms of balancing service and research missions?How much emphasis should we place on community outreach?How much effort should we invest in building CBOC partnerships? Are our strategies to recruit investigators appropriate?How can we use technology more effectively? How important is evaluation? 7. Should we create a methods core?

Presentations TodayPartnership between MIRECC – Clinical service Kathy Henderson, MD, & Michael Kauth, PhDResearch – John Fortney, PhDEducation – Michael Kauth, PhD Community outreach – Patricia Dubbert, PhDResearch training & recruitment – Mark Kunik, MD, MPH