Oct 26, 2016
Many veterans and their families struggle with behavioral health problems, yet they often face barriers to receiving adequate treatment. Notably, while many veterans are eligible to receive care at Department of Veterans Affairs (VA) facilities, family members are not and must seek care elsewhere. In seeking care in the community, veteran family members may face obstacles in ensuring that the care is sensitive to the issues that veteran families face and coordinated across providers.
Can a model of care that colocates and coordinates behavioral health services for veterans and their families address these barriers? The experiences in a new health center may shed light on this question. The Unified Behavioral Health Center (UBHC) for Military Veterans and Their Families is a public-private partnership between a VA medical center and a private-sector health care provider, both located in New York state. The center offers coordinated care for veterans and their families by locating VA and private providers side by side at the same facility.
RAND researchers evaluated the center's activities. The evaluation was intended to assess the viability of this new approach to behavioral health care, identify implementation challenges and successes, and assess the impact on patient health. The broader goal was to draw lessons to facilitate the center's replication elsewhere, should it prove successful.
The evaluation had two components. The first documented the center's capacity for delivering services (facilities, staff, technology, infrastructure) and the actual services delivered. The second assessed patient outcomes. For the first component, the evaluation used data from site visits and focus groups, as well as administrative data. For the second, it used patient-reported outcome data collected by UBHC staff.
The RAND evaluation provided recommendations for the UBHC and other providers that wish to learn from or replicate the UBHC model.
The UBHC has established strategies, policies, and procedures to enhance the collaborative effort. However, some of these practices have not been institutionalized. For example, there is currently a VA staff member informally acting as a liaison to coordinate care between the two sides of the center; the liaison role could be formalized to ensure that strong communication between organizations continues. More broadly, the VA Clinic at Bay Shore should consider formally protecting the time that their providers spend collaborating.
Collaboration could be further improved through a series of steps.
Integrate treatment plans. Collaboration would be enhanced by use of integrated treatment plans that staff on both sides of the center contribute to and can readily access.
Share access to patient records. The collaboration would also be enhanced by providers on both sides of the center having easy access to each other's patient records, so that it is easier to track the care a patient is receiving from other providers.
Provide secure email. It would also be helpful if providers could securely email each other, so that communicating about a shared patient does not require a phone call or in-person consultation. This would be particularly important for a larger center, as the informal communication strategies used by the UBHC are difficult to scale up.
If patient interest in the center continues to grow, the UBHC may benefit from expanded staffing and physical space. In particular, increased staff at the VA Clinic at Bay Shore would ensure that there is availability to serve veterans who have family members receiving services on the Feinberg Division side of the UBHC.
As more settings work to serve veterans and their families experiencing behavioral health problems, it will be important to deliver evidence-based interventions to address those problems and, additionally, to ensure that needs are met across a continuum of services, including prevention (e.g., psychoeducation) and other types of support (e.g., financial and legal support, family services).
To increase the integration and coordination of services, as well as to enable better tracking of patient outcomes over time, the entire UBHC should implement the same set of patient-reported outcomes measures. This would better inform patient care and enable ongoing quality-improvement efforts across the partnering entities.
Overall, the UBHC has successfully implemented a promising public-private partnership model for providing, in the same facility, behavioral health care for veterans and their families. Providers coordinated efforts to deliver high-quality care, the center geared up to deliver a range of therapeutic services for a large number of patients in a relatively short time, patients were satisfied with the services they received, and patients' symptoms and functioning improved significantly over time.
The UBHC provides care that is oriented toward the needs of veterans' families. Family members we spoke with expressed that the UBHC plays a vital role in their communities, citing that, in their experience, providers not affiliated with the VA are insensitive to the impact of posttraumatic stress disorder and other special issues facing the families of veterans. Family members saw the UBHC as a unique place where military families could receive care and understanding. UBHC staff and patients alike touted the advantages of coordinated care for the different members of a family.
Although the model has been successfully implemented, with strong preliminary outcomes, there are areas for improvement. Although staff and patients were happy with the collaborative relationships between providers, collaboration could still be closer than it currently is. Staff members regularly have to circumvent various challenges to collaboration.
Other partnerships between local VA centers and private health systems can learn from the UBHC launch and implementation. Some barriers to establishing the center could be circumvented by other programs. For example, building the center was a complicated process, but some of the barriers could potentially be avoided by close communication between the private organization and the appropriate VA staff through all phases of development, with key players at the table from the start. Another potential barrier for other potential partnerships is cost. However, initial expenses could be reduced by using an existing facility rather than building a new one. Further, ongoing expenses could be reduced by billing patients from the start.
Overall, the evaluation suggests that a collaborative model of behavioral health care has been successfully implemented by the UBHC and has great potential to help veterans and their families.