Hogg Foundation for Mental Health

IHC Grantees Make Strides in Adopting Collaborative Care Model

December 1, 2006

The foundation's Integrated Health Care grantees are working closely with training consultants to implement the collaborative care model in their organizations. The grantees have worked hard to put their teams in place. Several of the sites are starting to treat patients using the new model.

In late September, Dr. Jürgen Unützer, chief of psychiatry at the University of Washington Medical School, and his University of Washington colleagues conducted a two-day training in Austin for the grantee organizations' collaborative care teams.

In the training, teams met individually with the training consultants to assess their progress to date and to plan their next steps. The training also included specialized sessions for people playing different roles on the team. Sessions for care managers, psychiatrists and psychologists, and primary care physicians covered key issues and helpful strategies in working as an effective team member in the respective roles.

The University of Washington consultation team also briefly introduced collaborative care team members to the web-based patient registry system developed for the initiative. In the weeks after the training, they held additional training calls with the teams to provide them with additional instructions in its use.

The patient registry is a clinical tool employed by the clinical care manager to track patients with identified mental health needs throughout their treatment. The registry contains patients' scores on mental health assessment tools, as well as a record of each contact that the primary care physician and care manager has or attempts to have with the patient. It is an essential element of collaborative care.

There are several ways to administer the registry - a paper record, an electronic system, or a web-based registry. Each has its own merits.

In consultation with the IHC grantees, the foundation opted to fund the development of a web-based system because of the numerous advantages it offers. For example, care managers and other collaborative care team members can log on to the secure site from any computer with internet access and input or view patient data, which greatly facilitates communication across distances.

Building on the training to date, Dr. Unützer and his colleagues are setting up monthly consultation calls with each grantee site and for team members by role. The grantee site calls will focus on challenges facing the team as they implement the model. The care manager calls and the psychiatrist and psychologist calls will provide a forum for people working in the same role at different sites to share ideas and problem solve together.

Collaborative care is an integrated health care model that has over 20 years of research demonstrating its efficacy and effectiveness. Developed as a mental health adaptation of Wagner's chronic care model of disease management, this integrated health care model focuses on building partnerships between physical health and mental health providers to manage the treatment of psychiatric disorders in the primary care setting.

Through the foundation's IHC Initiative, three-year grants have been made to community health centers around the state to adopt the collaborative care model and to address the real-world barriers they encounter as they implement the model.

The foundation's goal for the initiative is to identify effective solutions to these barriers, making collaborative care a feasible approach for Texas and ultimately improving the quality of mental health services provided in primary care.

The Collaborative Care Treatment Model

How does collaborative care work? A quick overview of the process:

The primary care physician works with patients who have identified mental health needs to develop a treatment plan, which includes referral to the care manager.
The care manager is a professional or paraprofessional who is responsible for tracking patients with identified mental health needs, educating them about their diagnosis, and monitoring their treatment response using a standardized assessment tool.
The care manager ensures that patients do not "slip through the cracks" by tracking patient contacts and treatment response in a patient registry, or database.
Each week, a psychiatrist provides consultation on the care manager’s caseload.
Using the patient registry, the care manager reviews patients who are not responding to treatment with the psychiatrist, who provides recommendations to the care manager, treating physician, and patient as indicated.
Care management contacts and psychiatric consultation are conducted in person, by phone, or via televideo link.
As treatment winds down, the care manager focuses on relapse prevention with the patient to help the patient prepare for and prevent future psychiatric episodes.