Collaborative Care Enhancement for Mental Health

(BHIP-CCM Trial)

Not currently 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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to enhance collaboration among mental health care teams supporting Veterans with mental health needs. It will test two methods to help teams adopt collaborative care practices: centralized technical assistance and implementation facilitation. Teams will first receive one method, then switch to the other to determine which is more effective. Veterans receiving care from these teams may be suitable participants, except those diagnosed with dementia. As an unphased trial, this study offers Veterans an opportunity to contribute to innovative improvements in mental health care.

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 prior data suggests that these implementation strategies are safe for mental health care teams?

Research has shown that the Collaborative Chronic Care Model (CCM), used in the BHIP Enhancement Project, effectively improves mental health. Studies have found that this model can greatly enhance the quality of life for people with multiple mental health issues.

Available information reports no negative effects linked to this approach. The CCM improves communication and coordination between healthcare providers, making mental health treatment more efficient and supportive. Since this project focuses on improving existing care practices rather than testing a new drug or device, it generally involves low risk.

In summary, the BHIP-CCM Enhancement Project appears safe, with no major safety concerns reported in the research. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Collaborative Care Enhancement for Mental Health trial because it aims to optimize mental health care delivery through innovative techniques. Unlike traditional approaches that might focus solely on medication or therapy, this trial explores a stepped wedge design that integrates Centralized Technical Assistance and Implementation Facilitation. This method enhances collaboration among healthcare providers, potentially leading to more cohesive and effective mental health care. By refining how care is coordinated, the trial hopes to improve patient outcomes and streamline the treatment process, making care more accessible and comprehensive for individuals with mental health conditions.

What evidence suggests that this trial's implementation strategies could be effective for enhancing collaborative care in mental health?

Research has shown that using Collaborative Chronic Care Models (CCMs) with Behavioral Health Interdisciplinary Program (BHIP) teams can improve mental health. In this trial, different waves will receive either Centralized Technical Assistance or Implementation Facilitation as part of the stepped wedge design. Studies have found that these models help reduce hospital visits for mental health issues among Veterans. Another study found that CCMs improved the quality of life related to mental health, especially for people with multiple health problems. Additionally, using CCMs in primary care settings has helped with conditions like depression. Overall, evidence supports that enhancing BHIP teams with CCM principles can effectively manage mental health conditions. ^{1 4 5 6 7}

Who Is on the Research Team?

Christopher J. Miller, PhD

Principal Investigator

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

Sara J. Landes, PhD MA BA

Principal Investigator

Central Arkansas Veterans Healthcare System , Little Rock, AR

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05997836

NCT05997836 | Behavioral Health Interdisciplinary Program BHIP team clinical effectiveness, as evidenced by reduction in mental health hospitalizations among Veterans treated by the BHIP teams that have received the ...

2. hsrd.research.va.gov hsrd.research.va.gov/impacts/chronic-care-model-mh.cfm

Positive Effect of Collaborative Chronic Care Model on VA ... A Collaborative Chronic Care Model that incorporated Behavioral Health Interdisciplinary Program teams to treat Veterans with mental health conditions.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6749976/

The Collaborative Chronic Care Model for Mental Health ... Extensive evidence indicates that Collaborative Chronic Care Models (CCMs) improve outcome in chronic medical conditions and depression treated in primary care.

4. link.springer.com link.springer.com/article/10.1007/s10488-022-01231-0

Sustainability of the Collaborative Chronic Care Model in ... CCM-based BHIP care was also associated with improved mental health-related quality of life for Veterans with three or more comorbid mental ...

5. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2726717

Effectiveness of Implementing a Collaborative Chronic ... This randomized clinical trial reports the process and outcomes of establishing the collaborative chronic care model in 9 mental health

6. hsrd.research.va.gov hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=3615

The Behavioral Health Interdisciplinary Program (BHIP ... We will present findings from the BHIP Enhancement Project, a stepped wedge implementation trial conducted at nine US Department of Veterans Affairs (VA) ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9633036/

Sustainability of the Collaborative Chronic Care Model in ... CCM-based BHIP care was also associated with improved mental health-related quality of life for Veterans with three or more comorbid mental health conditions, ...