Implementing Integrated Mental Health and Chaplain Care in a National Quality Improvement Initiative

Abstract

This paper describes the development, implementation, and outcomes of a quality improvement learning collaborative that aimed to better integrate chaplaincy with mental health care services at 14 participating healthcare facilities evenly distributed across the Department of Veterans Affairs (VA) and Department of Defense (DoD). Teams of healthcare chaplains and mental health professionals from participating sites sought to improve cross-disciplinary service integration in six key domains: screening; referrals; assessment; communication and documentation; cross-disciplinary training; and role clarification. Both chaplains and mental health providers across the entire facilities at participating sites were significantly more likely post collaborative to report having a clear understanding of how to collaborate and to report using a routine process for screening patients who could benefit from seeing the other discipline. Foundational efforts to enhance cross-disciplinary awareness and screening practices between chaplains and mental health professionals appearing particularly promising.

Relation Between Quality Improvement Collaboratives and Non-technical Skills Development: a Systematic Review of Complex Interventions

“…International patient safety goals were addressed in 10 studies, ve focused on improved communication between teams and/or with the patient/family, [19,20,26,37,39] three addressed falls reduction, [35,36,47] and two considered health care-related infection prevention. [30,38] Improvement of patient safety culture was the subject of three studies.…”

“…However, only ve studies evaluated improvement in NTS among the participating professionals/teams and none mentioned or assessed their contribution to the dissemination and sustainability of improvement (Table 1-See Additional le 1). [19,28,37,42,46] In the study by Stevens et al (2010), the participants evaluated their improvement with the following parameters: delivery system design, decision support, clinical information systems, patient selfmanagement, integration, healthcare system organisation, and community linkages. There was an improvement in the processes with a slight improvement in the clinical results.…”

“…[28] Nieuwsma et al (2017) observed that chaplains and mental health professionals improved communication that favoured patient care. [37] For Werdenberg et al (2018) the NTS were important to the success of the proposed improvement objectives. [42] The study by Bedwell et al (2018) highlighted that nurses' knowledge focused on improving tracheostomy care increase in the following points: general knowledge, identifying emergencies, performance, situation, goals, coping.…”

Dynamic Diffusion Network: Advancing moral injury care and suicide prevention using an innovative model

“…Mental Health and Chaplaincy, in collaboration with evaluation capacities provided by ADAPT, has a demonstrated track record of effectively training and equipping chaplains in integration with mental health, on both an individual provider level 12 , 14 , 15 , 47 , 48 , 49 , 50 and systems level. 16 This capacity building across VHA has optimally positioned Mental Health and Chaplaincy and ADAPT to develop a DDN bridging the disciplines of chaplaincy and mental health around the closely related, yet distinct, problems of moral injury and suicide prevention. This process also aligns with the VHA Innovation Ecosystem's Diffusion of Excellence program, which seeks to 1) identify, 2) facilitate early expansion, and 3) promote system-wide spread of innovative healthcare practices that have shown an impact on care, employee engagement, and/or administrative processes within VA facilities.…”

“…Within the Veterans Health Administration (VHA), these frontline providers include mental health professionals as well as clinical chaplains who have received intensive training in integrating evidence-based psychosocial modalities with their spiritual care. 12 , 13 , 14 , 15 , 16 …”