Carrie Edlund

Quality Enhancement Research Initiative

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JoAnn E. Kirchner

Central Arkansas Veterans Healthcare System

John C. Fortney

VA Puget Sound Health Care System

Louise E. Parker

Quality Enhancement Research Initiative

Xiaotong Han

Sun Yat-sen University

Mona J. Ritchie

Central Arkansas Veterans Healthcare System

David E. Pollio

University of Alabama at Birmingham

Cathy D. Sherbourne

RAND Corporation

Mary Sue Farmer

Mental Illness Research, Education and Clinical Centers

Carol E. Kaufman

Colorado School of Public Health

Ann M. Cheney

University of California, Riverside

Cooperative Institutions

University of Arkansas for Medical Sciences

Central Arkansas Veterans Healthcare System

Mental Illness Research, Education and Clinical Centers

United States Department of Veterans Affairs

Health Services Research & Development

Quality Enhancement Research Initiative

University of Washington

RAND Corporation

University of California, San Diego

Colorado School of Public Health

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Geographical Access and the Substitution of Traditional Healing for Biomedical Services in 2 American Indian Tribes

Medical Care (2012)

John C. Fortney Carol E. Kaufman David E. Pollio Janette Beals Carrie Edlund

American Indians who live in rural reservation communities face substantial geographic barriers to care that may limit their use of health services and contribute to their well-documented health disparities. The purpose of this study was to examine the impact of geographical access to care on the use of services for physical and mental health problems and to explore American Indians' use of traditional healing services in relation to use of biomedical services.We analyzed survey data collected from 2 tribes (Southwest and Northern Plains). Geographical access to the closest biomedical service was measured using a Geographic Information System, including road travel distance, elevation gain, and reservation boundary crossing.Use of biomedical services was unaffected by geographical access for Northern Plains tribal members with mental health problems and for Southwest tribal members with physical or mental health problems. For members of the Northern Plains tribe with physical health problems, travel distance (P=0.007) and elevation gain (P=0.029) significantly predicted a lower likelihood of service use. The use of traditional healing was unrelated to biomedical service use for members of the Northern Plains tribe with physical or mental health problems and for members of the Southwest tribe with physical health problems. For members of the Southwest tribe with mental health problems, the use of biomedical services increased the likelihood of using traditional healing services.Findings suggest that biomedical services are geographically accessible to most tribal members and that tribal members are not substituting traditional healing for biomedical treatments because of poor geographical access.

Tribe

10.1097/mlr.0b013e318268ab99

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Citations (16)

Using a multi-level approach to implement a primary care mental health (PCMH) program.

Families Systems & Health (2010)

JoAnn Kirchner Carrie Edlund Kathy Henderson Lawrence Daily Louise E. Parker

Successfully spreading innovation across large health care systems is a complex process requiring participation of stakeholders from a broad spectrum of professional backgrounds, skill sets, and organizational levels. We describe a process for engaging and activating stakeholders across individual, team, organization, and system levels to implement primary care-mental health integrated care programs in one regional Veterans Affairs health care network. Key stakeholders and researchers collaborated to propose and implement the program. Preliminary findings indicate that the program may reduce referrals to specialty mental health care.

Specialty

Veterans Affairs

Mental Health Care

10.1037/a0020250

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Citations (44)

Counselors Called for Service: Impact of Parental Deployment on Preschool Children

The Family Journal (2012)

Angie Waliski Patti Bokony Carrie Edlund JoAnn E. Kirchner

Children and families often experience stress from the physical or emotional absence of a parent due to deployment. The health of the family system plays a vital role in the successful transition through deployment and redeployment phases. Even very young children show signs of behavioral problems, sleep disturbances, depressive symptoms, and anxiety from parental deployment. This article reviews the literature concerning the impact of parental deployment on preschool aged children and current interventions and discusses implications for counselors assisting military families.

Military deployment

Service member

10.1177/1066480712438531

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Citations (15)

Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study

BMC Health Services Research (2017)

Mona J. Ritchie Louise E. Parker Carrie Edlund JoAnn E. Kirchner

We evaluated a facilitation strategy to help clinical sites likely to experience challenges implement evidence-based Primary Care-Mental Health Integration (PC-MHI) care models within the context of a Department of Veterans Affairs (VA) initiative. This article describes our assessment of whether implementation facilitation (IF) can foster development of high quality PC-MHI programs that adhere to evidence, are sustainable and likely to improve clinical practices and outcomes.Utilizing a matched pair design, we conducted a qualitative descriptive evaluation of the IF strategy in sixteen VA primary care clinics. To assess program quality and adherence to evidence, we conducted one-hour structured telephone interviews, at two time points, with clinicians and leaders who knew the most about the clinics' programs. We then created structured summaries of the interviews that VA national PC-MHI experts utilized to rate the programs on four dimensions (overall quality, adherence to evidence, sustainability and level of improvement).At first assessment, seven of eight IF sites and four of eight comparison sites had implemented a PC-MHI program. Our qualitative assessment suggested that experts rated IF sites' programs higher than comparison sites' programs with one exception. At final assessment, all eight IF but only five comparison sites had implemented a PC-MHI program. Again, experts rated IF sites' programs higher than their matched comparison sites with one exception. Over time, all ratings improved in five of seven IF sites and two of three comparison sites.Implementing complex evidence-based programs, particularly in settings that lack infrastructure, resources and support for such efforts, is challenging. Findings suggest that a blend of external expert and internal regional facilitation strategies that implementation scientists have developed and tested can improve PC-MHI program uptake, quality and adherence to evidence in primary care clinics with these challenges. However, not all sites showed these improvements. To be successful, facilitators likely need at least a moderate level of leaders' support, including provision of basic resources. Additionally, we found that IF and strength of leadership structure may have a synergistic effect on ability to implement higher quality and evidence-based programs.

Veterans Affairs

Health administration

Facilitation

Health Services Research

Evidence-Based Practice

10.1186/s12913-017-2217-0

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Citations (76)

Collaborative research between clinicians and researchers: a multiple case study of implementation

Implementation Science (2010)

Dean G. Blevins Mary Sue Farmer Carrie Edlund Greer Sullivan JoAnn E. Kirchner

Bottom-up, clinician-conceived and directed clinical intervention research, coupled with collaboration from researcher experts, is conceptually endorsed by the participatory research movement. This report presents the findings of an evaluation of a program in the Veterans Health Administration meant to encourage clinician-driven research by providing resources believed to be critical. The evaluation focused on the extent to which funded projects: maintained integrity to their original proposals; were methodologically rigorous; were characterized by collaboration between partners; and resulted in sustained clinical impact.Researchers used quantitative (survey and archival) and qualitative (focus group) data to evaluate the implementation, evaluation, and sustainability of four clinical demonstration projects at four sites. Fourteen research center mentors and seventeen clinician researchers evaluated the level of collaboration using a six-dimensional model of participatory research.Results yielded mixed findings. Qualitative and quantitative data suggested that although the process was collaborative, clinicians' prior research experience was critical to the quality of the projects. Several challenges were common across sites, including subject recruitment, administrative support and logistics, and subsequent dissemination. Only one intervention achieved lasting clinical effect beyond the active project period. Qualitative analyses identified barriers and facilitators and suggested areas to improve sustainability.Evaluation results suggest that this participatory research venture was successful in achieving clinician-directed collaboration, but did not produce sustainable interventions due to such implementation problems as lack of resources and administrative support.

Health Services Research

Health administration

Participatory Evaluation

10.1186/1748-5908-5-76

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Citations (77)

Childhood Conduct Problems and Other Early Risk Factors in Rural Adult Stimulant Users

The Journal of Rural Health (2008)

Teresa L. Kramer Xiaotong Han Carl G. Leukefeld Brenda M. Booth Carrie Edlund

ABSTRACT: Context: Understanding childhood risk factors associated with adult substance use and legal problems is important for treatment and prevention. Purpose: To examine the relationship of early substance use, conduct problems before age 15, and family history of substance abuse on adult outcomes in rural, stimulant users. Methods: Adult cocaine and methamphetamine users (N = 544) in rural Arkansas and Kentucky were interviewed. Data were analyzed using both bivariate analyses and multiple logistic and log‐linear regression models, with dependent variables being any substance abuse/dependence, stimulant abuse/dependence, total number of arrests since age 18 and days incarcerated since age 18. Findings: One third reported 3 or more conduct disorder problems prior to age 15; half reported initiation of substances (excluding alcohol) before age 15; and 60% reported family history of substance problems. All 3 variables were associated with adult substance abuse/dependence but only the latter two were associated with stimulant abuse/dependence. Conclusions: This study highlights early risk factors for adult substance abuse/dependence among rural stimulant users.

Stimulant

Methamphetamine

10.1111/j.1748-0361.2009.00198.x

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Citations (12)

The Role of Gender in Moderating Treatment Outcome in Collaborative Care for Anxiety

Psychiatric Services (2014)

Kathleen M. Grubbs Ann M. Cheney John C. Fortney Carrie Edlund Xiaotong Han

The aim of this study was to test whether gender moderates intervention effects in the Coordinated Anxiety Learning and Management (CALM) intervention, a 12-month, randomized controlled trial of a collaborative care intervention for anxiety disorders (panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder) in 17 primary care clinics in California, Washington, and Arkansas.Participants (N=1,004) completed measures of symptoms (Brief Symptom Inventory [BSI]) and functioning (mental and physical health components of the 12-Item Short Form [MCS and PCS] and Healthy Days, Restricted Activity Days Scale) at baseline, six, 12, and 18 months. Data on dose, engagement, and beliefs about psychotherapy were collected for patients in the collaborative care group.Gender moderated the relationship between treatment and its outcome on the BSI, MCS, and Healthy Days measures but not on the PCS. Women who received collaborative care showed clinical improvements on the BSI, MHC, and Healthy Days that were significantly different from outcomes for women in usual care. There were no differences for men in collaborative care compared with usual care on any measures. In the intervention group, women compared with men attended more sessions of psychotherapy, completed more modules of therapy, expressed more commitment, and viewed psychotherapy as more helpful.These findings contribute to the broader literature on treatment heterogeneity, in particular the influence of gender, and may inform personalized care for people seeking anxiety treatment in primary care settings.

Collaborative Care

10.1176/appi.ps.201400049

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Citations (32)