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2023 HSR&D/QUERI National Conference Abstract

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4038 — Whole Health Mental Health Care: How Can It Improve Clinicians’ Capacity to Provide High Quality, Person-Centered Treatment?

Lead/Presenter: Justeen Hyde
All Authors: Hyde JK (Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center and Boston University School of Medicine), Dvorin, K (Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System) Rai, Z (Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System)

Objectives:
Over the last decade, VA’s Office of Patient Centered Care and Cultural Transformation has worked collaboratively with healthcare leaders and researchers to transform our approach to healthcare. Referred to as Whole Health (WH) Care, the approach begins with understanding what matters most to Veterans. It offers traditional clinical services alongside complementary and integrative health (CIH) modalities and supportive services to promote well-being and empower patients. While the concept of WH resonates with many providers, how to implement it is less clear. This study aimed to gather input from VHA mental health providers regarding how WH Care is conceptualized and core components integrated into practice within mental health care, and the perceived value of a WH approach.

Methods:
Qualitative interviews were conducted with a sample of mental health providers from 5 VA Medical Centers. Inclusion criteria included completion of core WH trainings and documented WH encounters (e.g., WH CHAR4 codes or Health Factors) in the medical record. Providers were recruited via email invitation. Interviews explored descriptions and applications of a WH approach and perceived impacts of its use on Veterans and providers. A rapid qualitative analysis was conducted, which began with brief summaries created for each interview and information on core domains of interest (e.g., description of WH approach, use of WH approach, impacts) documented in analytic templates. The team iteratively discussed interviews and reviewed summaries across sites and provider types. Data regarding the range of ways WH was defined and integrated into practice, and common themes related to impacts were analyzed.

Results:
The sample (N = 26) consisted of providers working in mental health, primary care, and specialty (PTSD, pain) clinics. Integration of WH approaches occurred across four phases of care: 1) assessment and conceptualization, 2) treatment planning, 3) treatment delivery, and 4) referral and coordination. For assessment, participants incorporated additional questions to explore what matters most to patients and perceptions of functioning across multiple domains of well-being. These questions improved rapport and deepened providers’ understanding of patients’ life contexts. During treatment planning, providers described using shared decision-making strategies guided by patient priorities to identify conventional treatments and CIH modalities of interest. Initial investment in understanding what matters to patients also allowed providers to tailor interventions (e.g., prolonged exposure activity for PTSD). About half also described how they integrated CIH modalities and evidence-based psychotherapies in their treatment services. Finally, providers noted the short-term duration of conventional treatment services and the value of connecting patients to a range of CIH and well-being services to support recovery post-treatment.

Implications:
WH mental health care begins with understanding what matters to patients and offers access to a range of treatment options, including CIH. Findings suggest that this patient-centered approach improves providers’ ability to meet patients where they are at and engage them in services that are relevant and meaningful.

Impacts:
As VHA continues to transform how healthcare is provided, providers need concrete examples of how to operationalize WH approaches in clinical care. This study draws on practice-based evidence to highlight a range of examples and benefits of using a WH approach.