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Behavioral Health QUERI: Advancing 21st Century Mental Health Care for Veterans

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The Behavioral Health QUERI Program will advance the quality and outcomes of mental health care provided to Veterans in Department of Veterans Affairs (VA) settings by implementing a variety of evidence-based practices (EBPs) and using common conceptual frameworks, implementation strategies, measures, and analytic processes across projects. Program Impact Goal: Advance 21st century mental health care for Veterans by improving care for those with complex behavioral health conditions, including those at highest risk for suicide. To achieve our Impact Goal, the proposed Behavioral Health QUERI program will address three specific aims: Aim 1. Understand and enhance implementation, sustainability, and the business case for implementing evidence-based health care for Veterans with complex behavioral health conditions, including those Veterans at the highest risk for suicide, through implementation of three evidence-based practices (EBPs) across diverse VA mental health settings. Aim 2. Advance implementation science by (i) continuing to evaluate and refine tools and resources to support use of implementation facilitation (IF) to implement programs and practices that are responsive to VA priorities, (ii) determining when IF is needed versus centralized technical assistance in VA settings, and (iii) continuing to transfer IF knowledge and skills to implementation practitioners and researchers in partnership with our Implementation Facilitation Training Hub. Aim 3. Transfer implementation science and leadership knowledge and skills needed to support a learning health system to junior investigators through a comprehensive mentoring program. Veterans with complex behavioral health conditions (i.e., multiple mental health diagnoses) are at greater risk for premature morbidity and mortality, including suicide. To improve the quality and coordination of care of these Veterans, we will promote sustainment and spread of the collaborative chronic care model (CCM) within outpatient general mental health teams known as Behavioral Health Interdisciplinary Programs (BHIPs). Promising data suggest that aligning BHIP care practices with CCM elements (BHIP-CCM) improves mental health outcomes for Veterans, but work is needed to further spread and sustain this EBP [EBP-1]. To address VA?s highest clinical priority of suicide prevention, we are focused on implementing two EBPs that target chronic suicidality. We will support and evaluate the implementation of Dialectical Behavior Therapy (DBT), the gold standard psychosocial EBP for Veterans at high risk for suicide due to emotion dysregulation and behavioral dyscontrol [EBP-2]. Additionally, we will support and evaluate the implementation of Life Goals (LG), an EBP that provides self-management skills for those with bipolar disorder, through a collaboration between the Bipolar Disorders Telehealth Program (BDTH) and the REACH VET (RV) program [EBP-3]. The overall project goal, program aims, and the aims of each of the three EBP projects will support participating sites and VISNs in meeting national performance quality standards. They align with the FY20 draft Network Director and Medical Center Director Performance Plan critical elements. Building on our knowledge of facilitation and technical assistance, we will work with our partners to apply both implementation strategies. This process will be informed by the QUERI Implementation Roadmap and supported by the Implementation Core. We will conduct budget impact analyses to provide actionable guidance regarding the cost implications of these strategies. Our Mentoring Core will support mentoring of the next generation in implementation research in VA. Finally, our Rapid Response Team will allow us to continue partnering with operational partners to address time-sensitive requests.

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