Cover: The Unified Behavioral Health Center for Military Veterans and Their Families

The Unified Behavioral Health Center for Military Veterans and Their Families

Documenting Structure, Process, and Outcomes of Care

Published Oct 26, 2016

by Nicole K. Eberhart, Michael S. Dunbar, Olena Bogdan, Lea Xenakis, Eric R. Pedersen, Terri Tanielian

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Research Questions

  1. What resources and capacities were available for providing care in the UBHC?
  2. What barriers and facilitators to implementing this model of care did the center encounter?
  3. What services were delivered and what were the characteristics of the patients who received them?
  4. How did receiving care affect patients' behavioral health outcomes?

Many veterans and their families struggle with behavioral health problems, family reintegration difficulties, and relationship problems. Although many veterans are eligible to receive care at Department of Veterans Affairs health facilities, family members are generally not eligible and therefore must seek care elsewhere. This situation can pose a barrier to family members' access to care and also make it more difficult for veterans and families to receive high-quality services that are coordinated across providers.

A new model of behavioral health care is trying to address these barriers: Created by the Northwell Health System and the Northport Veterans Affairs Medical Center, the Unified Behavioral Health Center (UBHC) for Military Veterans and Their Families in New York state is a public-private partnership that is providing colocated and coordinated care for veterans and their families.

RAND evaluated the center's activities to document the implementation of a unique public-private collaborative approach for providing care to veterans and their families. The first component of the evaluation focused on documenting the structures of care (the capacities and resources that the center developed and employed) and the processes of care (the services delivered). The second component focused on outcomes of care. The evaluation suggests that, overall, the model has been successfully implemented by the UBHC and has great potential to be helpful to the veterans and families it serves.

Key Findings

Capacity for Care

  • The center was not designed to be fully integrated. One side serves veterans, while the other side is available to service members, veterans, and their families but primarily serves family members. Each side has separate entrances, information systems, and processes for monitoring performance.
  • The partnership between the two sides of the UBHC allows for convenient access to behavioral health services for veterans and family members and facilitates exchange of information between the different sides, which can improve coordination of care.

Barriers to Implementation and Service Delivery

  • Coordinating the construction of a new facility was challenging because of numerous regulatory considerations.
  • Some collaborative activities are not institutionalized and codified (e.g., a liaison between sides of the center).

Services Delivered

  • The two sides of the center had different patterns of service utilization: The VA side provided fewer services to a larger number of individuals, and the private health center side provided more-intensive services to fewer individuals. As a result, the overall number of patient encounters was comparable, despite very different patient loads.
  • Both sides succeeded in becoming operational and delivering a substantial amount of services (more than 7,000 behavioral health encounters on each side of the center) in the three years since opening.

Patient Outcomes

  • UBHC patients consistently expressed satisfaction with their experiences at the center and the care they received.
  • Adult and child patients treated on the private health center side showed improvement in key behavioral health outcomes.

Recommendations

Recommendations for the UBHC and for Other Providers Wishing to Learn from or Replicate the UBHC Model

  • Institutionalize and codify the practices that are working: For instance, a liaison role could be formalized to ensure that strong communication between organizations continues, and the VA side of the center should consider formally protecting the time that their providers spend collaborating.
  • Facilitate easier and closer collaboration by enhancing communication infrastructure: Collaboration would be further enhanced by integrated treatment plans across the center's two sides, mutual access to patient health records, and the ability to securely send emails between the two health systems.
  • Create a physical space that is conducive to collaboration and family friendly.
  • Ensure adequate capacity to meet patient needs: The UBHC may benefit from an expansion in both staffing and physical space.
  • Provide a continuum of evidence-based services: Community-based organizations and clinical settings should adopt a systematic approach for selecting, training, delivering, supervising, and monitoring the fidelity of evidence-based practices relevant to the population. In selecting evidence-based approaches, organizations wishing to replicate the UBHC model may want to focus on short-term approaches and techniques or services that require less expensive staff.
  • Prioritize outcome monitoring and quality improvement for the center as a whole: The UBHC and other similar centers should routinely reevaluate their battery of measures to choose the ones that are least burdensome to patients and most helpful for informing clinical decisionmaking and outcome monitoring. The entire UBHC should implement the same set of patient-reported outcomes measures to inform patient care and enable ongoing quality-improvement efforts across all partnering entities.

This evaluation was sponsored by the New York State Health Foundation and conducted within RAND Health.

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