Care Partners sites either implemented or build on existing IMPACT collaborative care (Unützer et al. 2002) or PEARLS (Ciechanowski et al. 2004) programs. We are sharing more background on these programs below though Learning Collaborative participants do not need to have one of these programs in place nor do they have to commit to pursuing one of these programs. We will offer background and personalized coaching on these programs within the Learning Collaborative for sites that are interested.
What is collaborative care?
Behavioral health problems such as depression, anxiety, alcohol or substance abuse are among the most common and disabling health conditions worldwide, collectively robbing millions of their chance to lead healthy and productive lives. The good news is that there are effective treatments for most mental health conditions. The bad news is that most people in need don’t receive effective care due to stigma, a shortage of mental health specialists, and lack of follow through.
Integrated care programs try to address this problem by providing both medical and mental health care in primary care and other clinical settings. Offering mental health treatments in primary care is convenient for patients, can reduce the stigma associated with treatment for mental disorders, builds on existing provider-patient relationships, and can help improve care for the millions of patients who have both medical and mental disorders. There is a wide range of integrated programs, some of which are based on evidence and some of which are not.
Collaborative care is a specific type of integrated care developed at the University of Washington that treats common mental health conditions such as depression and anxiety that require systematic follow-up due to their persistent nature. Based on principles of effective chronic care illness (Wagner, 1998), principles of collaborative care focus on defined patient populations tracked in a registry, measurement-based practice and treatment to target. Trained primary care providers and embedded behavioral health professionals provide evidence-based medication or psychosocial treatments, supported by regular psychiatric case consultation and treatment adjustment for patients who are not improving as expected.
Collaborative care originated in a research culture and has now been tested in more than 80 randomized controlled trials in the US and abroad. Several recent meta-analyses make it clear that collaborative care consistently improves on care as usual. It leads to better patient outcomes, better patient and provider satisfaction, improved functioning, and reductions in health care costs, achieving the Triple Aim of health care reform. Collaborative care necessitates a practice change on multiple levels and is nothing short of a new way to practice medicine, but it works. The bottom line is that patients get better.
Collaborative Care Implementation Resources:
Teambuilding & Workflow
In usual care, the depression treatment team has two members: the primary care provider and the patient. Collaborative care adds two new team members: the care manager(s) and the psychiatric consultant. Each role is vital to ensuring high-quality, collaborative care. Effective collaborative care creates a team in which all of the providers work together on a single treatment plan. Its success relies to a great extent on each member of the treatment team understanding his/her role and believing he/she has the knowledge and skills necessary to fulfill that role.
The Team Building and Workflow Guide refers to the following AIMS Center resources:
- Team Member Self-Assessment
- Task Summary Worksheet
- Clinical Workflow Plan
- Action Plan Worksheet
- Administrative Readiness Checklist
Team Member Job Descriptions:
Use the AIMS Center Resource Library to find materials about collaborative care including strategies for financing collaborative care.
What is PEARLS?
The Program to Encourage Active, Rewarding Lives (PEARLS) is a national evidence-based program for late-life depression developed around the same time as IMPACT collaborative care. PEARLS brings high quality mental health care into community-based settings that reach vulnerable older adults.
During six to eight sessions that take place in the client’s home and focus on brief behavioral techniques, PEARLS counselors empower individuals to take action and make lasting changes so they can lead more active and rewarding lives.
The PEARLS Program:
- Focuses on teaching each client the skills necessary to move to action and make lasting life changes
- Is delivered in the client’s home or other accessible community setting
- Is designed to be delivered in the community through social service or other trusted community-based organizations
- Takes a team-based approach, involving the PEARLS counselor, clinical supervisor, and health provider
- Aims to improve quality of life, as well as reduce depressive symptoms
- Is well-suited for individuals with chronic illness, including people with epilepsy
More information about the PEARLS program can be found on the UW Health Promotion Research Center website.