Sustainability of the Collaborative Chronic Care Model in Outpatient Mental Health Teams Three Years Post-Implementation: A Qualitative Analysis
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Our goal was to investigate the sustainability of care practices that are consistent with the collaborative chronic care model (CCM) in nine outpatient mental health teams located within US Department of Veterans Affairs (VA) medical centers, three to four years after the completion of CCM implementation. We conducted qualitative interviews (N = 30) with outpatient mental health staff from each of the nine teams. We based our directed content analysis on the six elements of the CCM. We found variable sustainability of CCM-based care processes across sites. Some care processes, such as delivery of evidence-based psychotherapies (EBPs) and use of measurement-based care (MBC) to guide clinic decision-making, were robustly maintained or even expanded within participating teams. In contrast, other care processes-which had in some cases been developed with considerable effort-had not been sustained. For example, care manager roles were diminished in scope or eliminated completely in response to workload pressures, frontline care needs, or the COVID-19 pandemic. Similarly, processes for engaging Veterans more fully in decision-making had generally been scaled back. Leadership support in the form of adequate team staffing and time to conduct team meetings were seen as crucial for sustaining CCM-consistent care. Given the potential impact of leadership turnover on sustainability in mental health, future efforts to implement CCM-based mental health care should strive to involve multiple leaders in implementation and sustainment efforts, lest one key departure undo years of implementation work. Our results also suggest that implementing CCM processes may best be conceptualized as a partnership across multiple levels of medical center leadership.
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Appropriate staffing (i.e., ensuring manageable workloads) and blocking time for team members were identified as critical to sustainment of a team-based model in the VA.
“Staff turnover contributed to discontinuity in Dialectical Behavior Therapy (DBT) team members [78], and appropriate staffing (i.e., ensuring manageable workloads) and blocking time for team members were identified as critical to sustainment of a team-based model in the VA [67].”
From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [67]
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McGuier, E. A., Kolko, D. J., Aarons, G. A., Schachter, A., Klem, M. L., Diabes, M. A., Weingart, L. R., Salas, E., & Wolk, C. B. (2024) · Implementation Science · doi:10.1186/s13012-024-01381-9 · Cited by 70 · see citing works
- Authors
- Miller, C. J., Kim, B., Connolly, S. L., Spitzer, E. G., Brown, M., Bailey, H. M., Weaver, K., & Sullivan, J. L.
- Affiliations
- Harvard University (US)
- VA Boston Healthcare System (US)
- United States Department of Veterans Affairs (US)
- Boston University (US)
- Corresponding author
- Miller, Christopher J.
- ORCID
- Venue
- Administration and Policy in Mental Health and Mental Health Services Research
- Published
- 2022-11-03
- Volume
- 50
- Issue
- 1
- Pages
- 151-159
- ISSN
- 0894-587X (ISSN-L)
- 1573-3289
- PMC
- PMC9633036
- OpenAlex
- W4308075000
- Cited by
- 10
- References
- 31
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 7
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Administration and Policy in Mental Health and Mental Health Services Research (publishedVersion, other-oa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Quality Enhancement Research Initiative (QUERI QUE 20-026)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- implementation sustainability, veterans' mental health services, care managers, measurement-based care, evidence-based psychotherapy, leadership support, leadership turnover, Department of Veterans Affairs, COVID-19 pandemic impact
- MeSH terms
- COVID-19, Humans, Mental Health, Mental Health Services, Outpatients, United States, United States Department of Veterans Affairs, Pandemics
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