Facilitating Action for Suicide Prevention by Learning Health Care Systems.

The Mental Health Research Network (MHRN), funded by the National Institute of Mental Health to serve as a national laboratory to improve mental health care, includes researchers embedded in 13 health systems in 15 states. This column describes practice changes and effectiveness and exploratory research undertaken by MHRN partners when they found a sustained elevated risk of suicide attempts among patients who reported suicidal ideation on the nine-item Patient Health Questionnaire. Challenges described include finding common ground between what health care systems and funding agencies find compelling, choosing study designs that balance research and clinical tensions, and implementing studies in ways that minimize disruption to health systems. The authors conclude that the greatest benefit to working collaboratively with care system partners is the opportunity to improve care and to simultaneously measure the impact of change.

Progress Monitoring in an Integrated Health Care System: Tracking Behavioral Health Vital Signs.

Progress monitoring implementation in an integrated health care system is a complex process that must address factors such as measurement, technology, delivery system care processes, patient needs and provider requirements. This article will describe how one organization faced these challenges by identifying the key decision points (choice of measure, process for completing rating scale, interface with electronic medical record and clinician engagement) critical to implementation. Qualitative and quantitative data will be presented describing customer and stakeholder satisfaction with the mental health progress monitoring tool (MHPMT) as well as organizational performance with key measurement targets.

The Role of Lean Process Improvement in Implementation of Evidence-Based Practices in Behavioral Health Care.

To effectively implement evidence-based practices (EBP) in behavioral health care, an organization needs to have operating structures and processes that can address core EBP implementation factors and stages. Lean, a widely used quality improvement process, can potentially address the factors crucial to successful implementation of EBP. This article provides an overview of Lean and the relationship between Lean process improvement steps, and EBP implementation models. Examples of how Lean process improvement methodologies can be used to help plan and carry out implementation of EBP in mental health delivery systems are presented along with limitations and recommendations for future research and clinical application.

Online cognitive behavioral therapy for depressed primary care patients: a pilot feasibility project.

CONTEXT: Cognitive behavioral therapy (CBT) is a goal-oriented treatment that guides patients to healthy thoughts and behaviors. Internet-delivered CBT with supportive coaching can be as effective as in-person psychotherapy treatment of depression. OBJECTIVE: To test the feasibility of engaging depressed primary care patients not currently receiving psychotherapy and to measure the outcomes of Internet-delivered CBT with supportive coaching. DESIGN: Pilot feasibility project. MAIN OUTCOME MEASURES: 1) Uptake rate. 2) Reduction in depressive symptoms (average score on 20-item Hopkins Symptom Checklist) from baseline to 4-month follow-up. METHODS: Medical records data were queried to identify patients experiencing a new episode of depression. Eligible patients were invited via secure messaging (patient and clinician communication using a secure Web site linked to the medical record) to participate in the Internet-delivered CBT program (also known as Thrive), which was algorithm-driven and delivered through didactic segments, interactive tools, and assessments. Patients completed a self-administered online follow-up survey four months after enrollment. RESULTS: Of 196 eligible patients who were sent an invitation, 39 (20%) enrolled in the Internet-delivered CBT program. At follow-up, enrolled patients experienced a clinically significant decrease (average = 46%) in depressive symptoms. Suicidal thoughts also decreased both overall and by severity. CONCLUSIONS: Seamless, scalable integration of Internet-delivered CBT into health care systems is feasible. The 20% uptake rate suggests that future work should focus on strategies to increase the initial response rate. One promising direction is the addition of "human touch" to the secure message invitation. Depression outcomes suggest promise for systemwide implementation of Internet-delivered CBT programs.

Is dropout after a first psychotherapy visit always a bad outcome?

OBJECTIVE: The authors compared outcomes reported by patients who did or did not return for treatment after an initial psychotherapy visit. METHODS: Members of a group health plan were surveyed about initial psychotherapy visits occurring between March and September 2010. The survey assessed satisfaction with care and therapeutic alliance during the visit and later clinical improvement. RESULTS: Of the 2,666 members who returned surveys, 906 (34%) did not return for a second visit within 45 days. The distribution of satisfaction, therapeutic alliance, and self-rated improvement scores between patients who did and did not return differed significantly (p<.001). Patients who did not return were more likely to report the most favorable and the least favorable outcomes. CONCLUSIONS: Failure to return after an initial psychotherapy visit can represent successful and satisfying treatment. Systematic outreach and outcome assessment are necessary to identify the patients who drop out of therapy after unsuccessful and unsatisfying treatment.

Improving satisfaction in patients receiving mental health care: a case study.

Patient satisfaction is increasingly becoming an important component of quality for behavioral health care systems. The following report describes Group Health Cooperative's Behavioral Health Services department experiences over a 5-year period in moving from uncertainty about the value of patient satisfaction and the ability to positively impact patient ratings to achieving a significant improvement in patient ratings of satisfaction with mental health care. In this process, the Behavioral Health Department developed a deeper understanding of patient requirements and improvement strategies which could impact these requirements. A description of the results achieved along with the role of quality improvement processes in understanding and improving patient satisfaction in mental health care is presented.

Personality assessment in today's health care environment: therapeutic alliance and patient satisfaction.

This article addresses the role of personality assessment-specifically the Rorschach (Exner, 2002)-]in the context of the health care industry's increased focus on patient satisfaction. When providing psychotherapy, a challenge to providing patient-centered care turns on understanding and acting on the key aspects of the patient's personality that are crucial to forming an effective alliance. This article includes a description and examples of how personality assessment can enhance therapists' understanding of the ideational, affective, and self-control aspects of complicated patients' problem-solving styles. This enhanced understanding in turn can lead to improved therapeutic alliance between therapists and patients and to increased patient satisfaction with their care. How to provide feedback to the therapist also is addressed.