Update on South Central Mental Illness

Research, Education & Clinical Center

(SC MIRECC)

Greer Sullivan, MD, MSPH

February 2011

South Central MIRECC 2011 Advisory Board Meeting

• VISN 16• South Central MIRECC• Achievements and challenges• Questions for the 2011 Advisory Board• Overview of today’s presentations

Veterans Integrated Service Network (VISN) 16

• 170,000 square miles• 8 states (AR, LA, TX, MS, OK, FL, MO, AL)

– 16 Senators– 30 Congressional districts

• 10 VA Medical Centers• 50+ CBOCs• $6.6 billion annual budget

Gulfport New Orleans

August 28, 2005

VISN 16 Veterans

• 1.9 million eligible veterans• 450,000+ served annually• Distinctive characteristics

– ethnically diverse– 51% rural– less educated, poorer– sicker: mental and physical health– large geriatric population – greatest number of OEF-OIF veterans

VISN 16 Mental Health• About 25% of veterans who use VA

services receive mental health care (roughly 120,000)

• Approximately 2000 mental health providers

• VISN 16 mental health product line: – Manager: Kathy Henderson, MD – Product Line Advisory Council (PLAC) – Monthly PLAC teleconference

VISN 16 Research Centers

• South Central MIRECC• Houston HSR&D program• Little Rock HSR&D program• GRECC (Little Rock)• TBI Research Center (Houston)• Mental Health QUERI (Little Rock)• Substance Use Disorder QUERI (Houston)

South Central MIRECC• Funded: 1998

• Adopted rural theme: 2008

MissionTo improve access to evidence-based

practices in rural and other underserved populations, especially vulnerable elderly veterans, veterans

affected by natural disasters, and returning veterans.

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SC MIRECC is a virtual VISN-wide center with 4 anchor sites.

Little Rock

Houston

Oklahoma City

New Orleans

SC MIRECC Organizational Chart

SCVAHCN Mental Health Product

Line

VISN Consumer Advisory Board

South Central VA Health Care

Network (SCVAHCN)

VHA Office of Mental Health Services

DIRECTORCO-DIRECTOR

National

Advisory Board

RESEARCH TRAINING CORE

(Kunik)

CLINICAL CARE CORE

(Dubbert)

RESEARCH CORE

(Fortney)

EDUCATION CORE

(Kauth)

Research Methods Consultation: MIDAS Fellowship Program

Grant Writing Scholars

Research / Pilot Studies Clinical Educator Grants

Communication

Clinician Training

TRIPS Program

MIRECC LEADERSHIP COUNCIL

Consultation to VISN 16 Product Line

Assistance with Implementation

Site Leaders

Anchor Site Leaders• Houston – Melinda Stanley, PhD• Little Rock – Jeff Pyne, MD• New Orleans – Joseph Constans, PhD• Oklahoma City – Tom Teasdale, DrPH

Administrative Support• Houston – Brenda Schubert, Mathilda Ceaser• Little Rock – Kristin Ward, Melonie Shelton• New Orleans – Kerri Faircloth• Oklahoma City – Linda Muse• Recruiting budget specialist

Advice of 2009 Advisory Board

• Define “big picture” issues for center• Become known as rural center• Focus on rural minorities• Utilize technology in education and research• Develop outreach to communities and CBOC’s• Emphasize implementation• Promote large scale, MIRECC-wide research

Lay Out “Big Picture” Issues

100% 100% 100%

Need mental health care Enter mental health care Receive high quality mental health care

100% 30% 10%

*Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627.

Rural residents are more likely to: • Receive no mental health care

• Seek care from informal “providers”

• Receive mental health care from PCPs

• Receive poorer quality care

• Receive medications only

• Have smaller social networks and remain longer in networks

• Be skeptical about mental health treatment effectiveness

• Be concerned about anonymity and stigma

• Value independence and stoicism

100% 30% 10%

ENGAGEMENT AND ACCESS

GAP

QUALITY OF CARE GAP

• CBOC’s

• Take treatment to patient

• Community engagement

• Evidence-based treatment

• Tailoring treatment

• Reorganize care

Become better known as a rural center and leader in rural mental health.

• National Rural Health Association

• Journal of Rural Health

• Texas A&M School of Rural Public Health

• VA State of the Art (SOTA) conference, “Improving Access to Care”

• Rural Mental Health Contracting Pilot

• Building relationships with VA Rural Centers (Salt Lake City, Iowa City)

Emphasize research on rural minority populations.

• Recruited two new African-American investigators

• Recruited three African-American fellows

• Starting a racial disparities interest group

Get on the technology bandwagon! • CBOC Partnership Program evolved into Community

of Practice professional networking site

• Development of on-line provider training

• Technology research applications- V-Tel - Measurement-based

tracking- CBT by phone - Smart phone apps- Virtual reality - Remote monitoring devices- Computer assisted CBT

Build outreach to communities using community based participatory research

(CBPR) approaches.

• ACCESS: rural “early responders” program- Clergy, court system, community colleges

• Community college outreach

• Education of community based, non-VA PCP’s

Promote and evaluate implementation.

Undertake larger VISN-wide research projects.

• Documented collaboration across MIRECC sites

• Sponsored two “mini-retreats” to plan MIRECC-wide projects; one resulted in HSR&D application

• Initiated two MIRECC-wide “working groups”(Technology, CBT)

• Started two HRS&D-funded VISN–wide projects (Fortney, Sullivan)

Challenges

• “Administrating” across four sites• Increasing administrative constraints• Balancing service to many masters• Recruiting • Using resources optimally • Documenting our value, impact, and

productivity

Questions for Board

1. How are we doing in terms of balancing service and research missions?

2. How much emphasis should we place on community outreach?

3. How much effort should we invest in building CBOC partnerships?

4. Are our strategies to recruit investigators appropriate?

5. How can we use technology more effectively?

6. How important is evaluation?

7. Should we create a methods core?

Presentations Today

• Partnership between MIRECC – Clinical service Kathy Henderson, MD, & Michael Kauth, PhD

• Research – John Fortney, PhD

• Education – Michael Kauth, PhD

• Community outreach – Patricia Dubbert, PhD

• Research training & recruitment – Mark Kunik, MD, MPH