Collaborative Care Enhancement for Mental Health

(BHIP-CCM Trial)

Recruiting at 16 trial locations

Overseen By Madisen E Brown

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Dementia

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

81424 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on improving care practices rather than changing individual treatment plans.

What data supports the effectiveness of the treatment Behavioral Health Interdisciplinary Program - Collaborative Chronic Care Model (BHIP-CCM) Enhancement Project 2.0?

Research shows that collaborative chronic care models (CCMs) improve outcomes for various mental health conditions and chronic medical issues, including depression, when used in primary care settings. These models have been successfully implemented in mental health clinics, leading to better patient health status and perceptions of care. ^{1 2 3 4 5}

Is the Collaborative Care Enhancement for Mental Health generally safe for humans?

The available research does not specifically address safety concerns for the Collaborative Care Enhancement for Mental Health, but collaborative chronic care models (CCMs) have been widely studied and are generally considered safe for improving mental and physical health outcomes in individuals with mental disorders. ^{1 3 5 6 7}

How is the Collaborative Care Enhancement for Mental Health treatment different from other treatments for mental health conditions?

This treatment is unique because it integrates mental health care into primary care settings using a team-based approach, which can improve outcomes by providing comprehensive care in one location. It focuses on collaboration between different healthcare providers to manage mental health conditions more effectively than traditional, fragmented care models. ^{2 3 8 9 10}

What is the purpose of this trial?

This quality improvement project aims to help outpatient mental health teams, known as Behavioral Health Interdisciplinary Program (BHIP) teams, adopt more collaborative care practices (consistent with the collaborative chronic care model or CCM). The investigators therefore aim to use two different implementation strategies -- centralized technical assistance and implementation facilitation -- to align BHIP teams' care practices more closely with the principles of the CCM.

Research Team

Sara J. Landes, PhD MA BA

Principal Investigator

Central Arkansas Veterans Healthcare System , Little Rock, AR

Christopher J. Miller, PhD

Principal Investigator

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Eligibility Criteria

This trial is for veterans receiving care from Behavioral Health Interdisciplinary Program (BHIP) teams at certain medical centers. It includes those treated for mental health issues, except patients with a dementia diagnosis. Clinicians working on BHIP Teams are also part of the study.

Inclusion Criteria

Primary inclusion criterion at the provider level is clinicians working on BHIP Teams at the participating medical centers

My treatment site will decide the support method.

Primary inclusion criterion at the patient level is Veterans treated by the BHIP teams at the participating medical centers

Exclusion Criteria

Patients with a diagnosis of dementia in the electronic medical record

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation Facilitation

BHIP teams receive implementation facilitation to align care practices with the collaborative chronic care model

8 months

Ongoing support and facilitation sessions

Centralized Technical Assistance

BHIP teams receive centralized technical assistance to improve team collaboration and clinical effectiveness

8 months

Ongoing technical assistance sessions

Follow-up

Participants are monitored for outcomes such as team development and mental health hospitalization rates

12 months

Treatment Details

Interventions

• Behavioral Health Interdisciplinary Program - Collaborative Chronic Care Model (BHIP-CCM) Enhancement Project 2.0

Trial Overview The project tests two strategies to improve outpatient mental health care: centralized technical assistance and implementation facilitation. The goal is to make team practices align better with collaborative chronic care models.

Participant Groups

Group I: Wave 4 Experimental Treatment 2 Interventions

Study design is a stepped wedge; Wave 4 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation

Group II: Wave 3 Experimental Treatment 2 Interventions

Study design is a stepped wedge; Wave 3 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation

Group III: Wave 2 Experimental Treatment 2 Interventions

Study design is a stepped wedge; Wave 2 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation

Group IV: Wave 1 Experimental Treatment 1 Intervention

Study design is a stepped wedge; Wave 1 begins by receiving Implementation Facilitation

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

US Department of Veterans Affairs Office of Mental Health and Suicide Prevention

Collaborator

Trials

1

Recruited

81,400+

Findings from Research

Implementation facilitation in mental health teams significantly improved team processes and clarity of roles, with notable increases in team development measures, indicating that structured support can enhance collaborative care models in real-world settings.

While overall self-reported health status showed little improvement, veterans with multiple mental health diagnoses experienced significant health status gains, and there was a marked reduction in hospitalization rates during the facilitation period, suggesting targeted benefits for complex cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Implementing a Collaborative Chronic Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health: A Randomized Clinical Trial. Bauer, MS., Miller, CJ., Kim, B., et al.[2020]

The Collaborative Care (CC) model was successfully implemented in a nurse-managed health center in Chicago, serving 166 patients in its first year, with 22% achieving depression treatment goals and 47% for anxiety.

This model not only improved patient outcomes by addressing both mental and physical health needs but also enhanced the collaboration between primary care providers and behavioral health specialists, boosting the confidence of family nurse practitioners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting. Reising, V., Diegel-Vacek, L., Dadabo, L., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

One-Year All-Cause Mortality and Delivery of the Collaborative Chronic Care Model in General Mental Health Clinics. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Partnering with health system operations leadership to develop a controlled implementation trial. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of Implementing a Collaborative Chronic Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health: A Randomized Clinical Trial. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

The Collaborative Chronic Care Model for Mental Health Conditions: From Evidence Synthesis to Policy Impact to Scale-up and Spread. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Implementing a Learning Collaborative for Population-Based Physical and Behavioral Health Integration. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Collaborative chronic care models for mental health conditions: cumulative meta-analysis and metaregression to guide future research and implementation. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Provision of Collaborative Care Model and General Behavioral Health Integration Services in Medicare. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Practical and measurable definitions of care coordination, care management, and case management. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

The White River model of colocated collaborative care: A platform for mental and behavioral health care in the medical home. [2010]