1. Partnership with the Mental Health Product Line Kathy L. Henderson, MD Michael R. Kauth, PhD February 2011

2. South Central VA Health Care Network Mental Health Product Line Organizational Chart Deputy Manager Administrative Officer Integrated Care Coordinator Administrative Support Assistant Network Homeless Coordinator Deputy Network Homeless Coordinator Administrative Support Assistant Network Suicide Prevention Coordinator Manager

3. Mental Health Product Line Advisory Council (MHPLAC) VISN 16 MHPLAC –Led by VISN 16 MHPL Manager –Composed of Key MH leaders from each facility –Chief of Staff, Social Work, Nurse Representatives –Medical Center Director Champion – Julie Catellier (New Orleans) –MIRECC Representative—Associate Director for Clinical Care (Pat Dubbert, PhD) –18 Program Specific Workgroups

4. Mental Health Programs Inpatient Psychiatry (Acute, Intermediate, STAR) Mental Health Residential Treatment Program (Doms, RRTPs) Ambulatory Mental Health Mental Health Disaster Teams Evidence-based Psychotherapies Psychosocial Rehabilitation (CWT/SE, PRRCs) Primary Care MH MHICM Homeless Programs Suicide Prevention Telemental Health MST SUD PTSD MH OEF-OIF

5. MIRECC’s Role with the MHPLAC Works with all facilities and CBOCs Addresses educational priorities/provides training identified by facilities Communicates with providers thru newsletter, COP, individually Engages CBOC providers in MIRECC mission Assists with implementation of new clinical programs Provides direction/consultation for clinical proposals and educational grants Voting member of MHPLAC

6. President’s New Freedom Commission 2003 VHA Comprehensive MH Strategic Plan 2004 Uniform MH Services Handbook 2008 T21 Implementation 2010 Zero Veteran Homelessness Improve Veterans Mental Health

7. MH Enhancement Initiative FTEE & Funding (FY05-FY10) FTEECO Funding 2005 47.5$3,399,786 2006 121.55$10,348,659 2007 161.65$16,158,344 2008 66.0$6,457,726 2009 129.15$12,691,401 2010 33.5$3, 567,573 VISN559.35$52,623,489 90% fills thru September 2010

8. Growth in Mental Health Uniques (FY05-FY10)

9. Priorities for MHPL Implement Uniform MH Services Handbook Maintain mental health staffing enhancements Increase access to specialty mental health services in rural areas Expand technology –telemed, social networking, in home treatment Review need for additional MH specialty/residential beds HOMELESS! HOMELESS! HOMELESS! –Zero homelessness in 4 years

10. VISN 16 MH Clinical Education Priorities Only undertake initiatives that are supported by the MHPLAC (often directly related to UMHS Handbook implementation) MIRECC survey of 10 medical center MH programs and their CBOCs: VAMC s CBOCs 1.Brief SUD interventions 1. Motivation interviewing, general 2.DBT skills 2. Treating vets with PTSD and TBI 3.Motivational interviewing, general 3. Suicide prevention 4.SUD psychotherapy (CBT) 4. Marital therapy/couples therapy 5.Suicide prevention 5. Brief SUD interventions

11. Update on Past Projects 1. UMHS DVDs to VISN 16 CBOCs www.mirecc.va.gov/VISN16/umhshs/umhshEducation.asp 2. CBT in VA medical center and community clinics: An implementation pilot – 3 published papers

12. Kauth, M.R., Sullivan, G., Cully, J., & Blevins, D. (in press). Facilitating practice changes in mental health clinics: A guide for implementation development in health care systems. Psychological Services. Kauth, M.R., Sullivan, G., Blevins, D., Cully, J.A., Said, Q., Teasdale, T.A., & Landes, R.D. (2010). Employing external facilitation to implement cognitive behavioral therapy in VA clinics: A pilot study. Implementation Science, 5. www.implementationscience.com/content/5/1/75 Cully, J.A., Teten, A.L., Benge, J., Sorocco, K.H., & Kauth, M.R. (2009). Multidisciplinary cognitive-behavioral therapy training for the VA primary care setting. Journal of Clinical Psychiatry: Primary Care Companion, 12(3), e1-e8.

13. Selected New Projects Guide to VA Mental Health Services for Veterans & Families www.mirecc.va.gov/visn16/ and in hardcopy For veterans to know what services are available where they live and to expect such services

14. Selected New Projects Online Working with Couples Modules Urgent clinical need by MHPLAC –Two workshops + consultation in 2009 (Houston, Little Rock) for 58 MH clinicians (40% from CBOCs) –MIRECC grant to produce 6 online modules + consultation in 2011; pilot with 80 MH clinicians –Goal = increase training reach Play clip

15. Selected New Projects Promoting Telepsychotherapy Urgent clinical need by MHPL CBOC Needs Assessment found TeleHealth system underused –Team: Kauth, Greene (NCPTSD), Sorocco (OKC VA), Deen (LR VA), Smith (Wichita Falls CBOC) –Pilot with 13 therapists who will provide EB psychotherapy to 7 clinics –Assessment barriers and action to resolve + VTEL training with therapists + follow up –Goal = reduce clinician anxiety; increase comfort; speed implementation

16. Selected New Projects TBI Assessment Modules Urgent clinical need by MHPLAC –Basics of good TBI assessment –Goal = increase training reach Play clip

17. Questions?