Envisioning Transformation in VA Mental Health Services Through Collaborative Site Visits.

This column reviews the unique contributions of multiple partners in establishing a standardized site visit process to promote quality improvement in mental health care at the Veterans Health Administration. Working as a team, leaders in policy and operations, staff of research centers, and regional- and facility-level mental health leaders developed a standardized protocol for evaluating mental health services at each site and using the data to help implement policy goals. The authors discuss the challenges experienced and lessons learned in this systemwide process and how this information can be part of a framework for improving mental health services on a national level.

Differential relationships between continuity of care practices, engagement in continuing care, and abstinence among subgroups of patients with substance use and psychiatric disorders.

Objective: We examined whether patient subgroups with differing substance use disorders (SUDs) and psychiatric severity levels varied on engagement in continuing care and abstinence outcomes, the association of continuity of care practices to engagement, and the association of engagement to abstinence.

Method: Staff in 28 Veterans Affairs SUD treatment programs used the Addiction Severity Index to assess 865 (98% male) patients' alcohol, other drug, and psychiatric problems at treatment entry. At discharge, staff supplied data on patients' treatment, motivation, and continuity of care practices.

VA nursing home residents with substance use disorders: Mental health comorbidities, functioning, and problem behaviors.

Objectives: This research addresses whether residents with substance use disorders (SUDs) in VA nursing homes (VANHs) are distinctive in terms of their demographic characteristics, medical and mental health comorbidities, functioning, and problem behaviors.

Methods: Residents over age 55 admitted to VANHs (n = 27,002) were identified in VA administrative files, and SUD and non-SUD residents were compared.

Results: Compared with other residents, the residents with SUDs (18% of admissions over age 55) were more likely to be younger, male, African-American, unmarried, have low income and a tobacco use disorder.

Recent changes in the prevalence of psychiatric disorders among VA nursing home residents.

Objective: This study identified recent changes in the prevalence of psychiatric disorders among Department of Veterans Affairs (VA) nursing home residents.

Methods: Psychiatric diagnoses in administrative databases were summarized for nursing home residents in 1998, 2002, and 2006. Census prevalence rates were compared with findings from earlier VA nursing home surveys.

Treatment staff's continuity of care practices, patients' engagement in continuing care, and abstinence following outpatient substance-use disorder treatment.

Objective: Although speculation suggests that continuity of care predicts abstinence following substance-use disorder (SUD) treatment, models examining staff's continuity of care practices and engagement in continuing care and whether they mediate or moderate the association between patient and treatment factors and abstinence are lacking. In this study, we aimed to model abstinence using combinations of independent pretreatment and treatment factors, discharge continuity of care practices, and posttreatment engagement and to identify mediators or moderators of relationships between these factors and abstinence.

Method: Staff in 18 Department of Veterans Affairs (VA) outpatient SUD programs used the Addiction Severity Index to assess 429 nonabstinent patients' alcohol and drug problems at treatment entry.

Predictors of engagement in continuing care following residential substance use disorder treatment.

Background: Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment.

Methods: Patients (n=3032) at 15 geographically diverse SUD residential treatment programs provided data on demographics, symptom patterns, recovery resources, and perceptions of treatment environment.

Continuity of care practices and substance use disorder patients' engagement in continuing care.

Background: Substance use disorder (SUD) patients who engage in more continuing care have better outcomes, but information on practices associated with greater patient engagement and retention in continuing care remains elusive.

Objectives: The objectives of this study were to determine if staff's continuity of care practices predict patients' engagement in continuing care in the 6 months after discharge from intensive SUD treatment and to determine if the impact of continuity of care practices on patients' engagement in continuing care differs for patients treated in inpatient/residential versus outpatient programs.

Research Design: Staff in 28 Veterans Affairs (VA) intensive SUD treatment programs with varying continuity of care practices provided data on 878 patients' alcohol and drug problems at treatment entry.

Assessing continuity of care practices in substance use disorder treatment programs.

Objective: The purpose of this article is to describe the development and psychometric properties of parallel program-level and individual-level versions of the Continuity of Care Practices Survey (CCPS-P and CCPS-I), a measure that assesses four dimensions of continuity of care practices in substance use disorder (SUD) treatment programs. CCPS subscales assess staff efforts to ensure provider continuity, maintain contact with patients, coordinate care among providers and connect patients to community resources.

Method: Program-level CCPS data were obtained from directors/coordinators of 129 intensive inpatient/residential and outpatient Department of Veterans Affairs SUD programs.