Globally, children and youth are more vulnerable to experiencing mental health challenges; early intervention is key to preventing ongoing mental health difficulties into adolescence and adulthood. School-based mental health interventions have proven to be effective but require a significant amount of collaboration between teachers, parents, mental health specialists and other important stakeholders. Equally noteworthy are the significant treatment, resource and capacity gaps between high and low to middle income countries when it comes to child mental health; the SHINE research group seeks to implement a school-based mental health program in countries in the Eastern Mediterranean region. They also intend to scale-up the prevention and intervention capabilities of said countries to improve overall child mental health. This study investigated the role of collaborative care in SHINE’s program development and implementation processes, while examining the cultural and societal challenges associated with implementing a school mental health program developed primarily in high-income countries to specific non-Western contexts. Individual and small-group indepth interviews were conducted with ten key stakeholders from the SHINE team and partner countries (specifically Iran, Jordan and Egypt). Findings identified the potential for the collaborative care approach within the SHINE school mental health program to greatly ameliorate child mental health outcomes. Additionally, participants noted the necessity for clearer stakeholder role definition and differentiation of general vs specific program elements between countries. Challenges associated with implementing the intervention in the Eastern Mediterranean region included the dominant role of the family, challenging societal norms and stigmatization and structural barriers to applying SHINE’s specific program resources. In summary, the role of collaborative care is increasingly important to SHINE’s current efforts in improving child mental health, however, individual cultural and country characteristics should be an area of emphasis moving forward. / Thesis / Master of Science (MSc) / The SHINE research group are implementing a school-based mental health intervention in the Eastern Mediterranean region, alongside a facilitated collaborative learning group involving key local and global stakeholders. This study focuses on the collaborative care element of the school-based mental health program and its impact on the overall functioning of the intervention, in different country contexts. Collaborative care involves the interactions between parents, teachers, mental health professionals and researchers to ensure the sustainability of the program as well as its scalability to different country contexts. This is an exploratory qualitative study with a case study design; data has been collected with ten participants through individual and small group in-depth interviews. Interviews were transcribed, coded and then cross-compared using thematic analysis to identify overarching patterns. The primary goals of the study are to examine the role of collaboration as well as to consider some of the challenges of applying Western psychological interventions to diverse country and cultural contexts.

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Yes / Current NHS policy encourages an integrated approach to provision of mental and physical care for individuals with long term mental health problems. The 'PARTNERS2' complex intervention is designed to support individuals with psychosis in a primary care setting. The trial will evaluate the clinical and cost-effectiveness of the PARTNERS2 intervention. This is a cluster randomised controlled superiority trial comparing collaborative care (PARTNERS2) with usual care, with an internal pilot to assess feasibility. The setting will be primary care within four trial recruitment areas: Birmingham & Solihull, Cornwall, Plymouth, and Somerset. GP practices are randomised 1:1 to either (a) the PARTNERS2 intervention plus modified standard care ('intervention'); or (b) standard care only ('control'). PARTNERS2 is a flexible, general practice-based, person-centred, coaching-based intervention aimed at addressing mental health, physical health, and social care needs. Two hundred eligible individuals from 39 GP practices are taking part. They were recruited through identification from secondary and primary care databases. The primary hypothesis is quality of life (QOL). Secondary outcomes include: mental wellbeing, time use, recovery, and process of physical care. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action, and look for unintended consequences. An economic evaluation will estimate its cost-effectiveness. Intervention delivery and follow-up have been modified during the COVID-19 pandemic. The overarching aim is to establish the clinical and cost-effectiveness of the model for adults with a diagnosis of schizophrenia, bipolar, or other types of psychoses. / PARTNERS2 is funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research Programme (grant number: RP-PG- 200625). This research was also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust.

Yes / In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The initial programme theory was developed from these sources in an iterative process between researchers and stakeholders (service users, practitioners, commissioners) involving four activities: articulation of 442 explanatory statements systematically developed using realist methods; debate and consensus; communication; and interrogation. We refute two criticisms of theory-driven evaluation of complex interventions. We demonstrate how the process of initial theory-building made a meaningful contribution to our complex intervention in five ways. Although time-consuming, it allowed us to develop an internally coherent and well-documented intervention. This study and the lessons learnt provide a detailed resource for other researchers wishing to build theory for theory-driven evaluation. / This research was funded by a UK NIHR Programme Grant (RP-PG-0611- 20004) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula).

Collaborative efforts between medical and behavioral health professionals is required to simultaneously treat individuals with medical and mental health disorders. However, there is lack of focus on the competencies and trainings needed by behavioral health clinicians (BHCs) transitioning to integrated primary care (IPC) settings. The purpose of this qualitative interpretive phenomenological study was to describe the lived experiences of BHCs who have transitioned from specialty outpatient behavioral healthcare settings to IPC settings. Semi-structured interview questions were used to collect data. Using interpretive phenomenological data analysis approach, themes and the shared meanings and experiences of 8 licensed BHCs were explored. Seven participants had graduate degrees and 1 participant had post-graduate degree. All participants had at least a year of experience working in IPC settings, worked full-time in North Carolina, and had over a year of experience in traditional behavioral healthcare settings. Results indicated that participants shared experiences in 5 themes: (a) clinical experience, (b) effective communication, (c) collaboration with primary care providers(PCPs), (d) continued education and trainings, and (e) care coordination. The outcome of this research will inform institutions, administrators, and credentialing boards to consider implementation of defined competencies for BHCs in community health centers that operate on IPC principles to ensure collaborative efforts between BHCs and PCPs in order to help provide effective holistic and affordable health care in a systems-based approach.

Department structure and leadership functions can influence work climate. In one healthcare system, advanced practice providers (APPs) worked in a decentralized structure with multiple leaders. This project explored the impact of the change to centralized leadership for APPs working in an academic healthcare system in which employee turnover was high and satisfaction was low. An ad hoc committee led by the chief medical officer created a centralized department with a designated leader. Surveys and interviews were used to identify the benefits of the strategies implemented and understand whether the change in organizational structure resulted in an improved work climate for APPs in the large multicampus academic healthcare system,. Data were collected from departmental reports, 12 APP interviews, and 2 online surveys with a total of 73 responses. Results showed that centralization improved leadership support and communication with APPs within the system by 11.4%. Feedback from APPs indicated the physicians maximized APPs' expertise and licensure, thus creating a supportive work climate and environment, professional growth, and job satisfaction. With the implementation of the centralized department in 2014, the turnover rate dropped from 20.47% in 2013 to 6.1% in 2016 resulting in positive social change for APPs, providers, and patients.

Many studies have reported that the training for practitioners does not stimulate reflexes that contribute to the tenets of teamwork and collaboration. No studies were found to investigate relational intelligence (RQ) in pharmacist-physician relationships as a catalyst for collaborative and hence cost effective quality care. This study addressed the role and potential opportunity to promote RQ as a critical leadership skill in the collaboration between pharmacists and physicians. Using RQ as the conceptual framework, this phenomenological study explored how pharmacists and physicians in a hospital setting perceive RQ as a leadership skill when working collaboratively. A total of 10 participants (5 pharmacists and 5 physicians) from a 443-bed comprehensive hospital in Michigan were selected using purposive sampling. Pharmacists and physicians included had at least 4 years of hospital experience. Data were collected through semistructured in-depth interviews and analyzed using the hierarchical approach. Results indicated interest among both pharmacists and physicians to use RQ as a leadership skill to work collaboratively. Further findings highlighted the need for face-to-face communication between pharmacists and physicians, better collaboration, accountability, feedback, focus and alignment, promotion of positive relationships, and a leadership position directed by a PhD-prepared practitioner with expertise in RQ. These findings bring awareness to both pharmacists and physicians of barriers to collaboration; these findings also suggest the need for multidisciplinary training that incorporates RQ theory as a foundation for both pharmacists and physicians, which may decrease health care costs while improving communication, trust, mutual understanding, collaboration, and quality care.

The objective of this dissertation is to describe a systematic approach to effectively treat common mental health disorders, which involves integrating care managers and mental health specialists into the primary care treatment team. Despite an extensive body of evidence demonstrating the effectiveness of collaborative care, implementation in various “real world” settings presents a number of barriers. Successful clinical trials have failed to result in widespread changes in practice. Gaps in the literature persist as to what the clinical, organizational and financial barriers to integration are. As a result, dissemination of the model lags far behind. This dissertation sought to contribute new information to the literature on integrated health care by examining various elements of dissemination efforts. The first article examined the experience among a group of health care providers in Texas who were attempting to integrate physical and behavioral health care. This article identified the barriers that they have encountered in addition to the strategies they have used to integrate mental and physical health services, and to determine whether the strategies reflect an evidence-based model of care delivery. In addition, the perceived clinical, organizational and financial barriers to integration were evaluated. The second article for this dissertation examined quantitative clinical outcomes of an integrated health care program in a community-based clinic with a low-income, uninsured population of Hispanics, a portion of which were Spanish-speaking. A socio-culturally adapted model for the provision of comprehensive health services may have a significant impact on the health and mental health outcomes of minority, non-English speaking populations. The third article offers an in-depth case study of an interdisciplinary collaborative care treatment team. Understanding the details of program implementation and the elements of the model that community based providers found useful, and those they found challenging, has implications for widespread implementation efforts. This qualitative article offered an analysis of how the treatment team organized itself to perform as a coordinated, high functioning effort that fit well with the needs of patients, and had each professional doing what they do best. / text

Hensikt: Kartlegge ulike samhandlingstiltak for pasienter med lett til moderat depresjon, og vurdere effekter av de identifiserte tiltakene for pasientene og helsetjenesten. Metode: Oppsummering (meta-oversikt) av systematiske oversikter. Litteratursøk: Medline, Cochrane Library, SWEMED, EMBASE and Cinahl database. Seleksjonskriterier: Systematiske oversikter publisert 1995-2006 om effekter av samhandling i allmennpraksis om voksne pasienter med lett til moderat depresjon. Kontrolltiltak var standard behandling gitt i allmennpraksis. Eksklusjonskriterier: Studier med overvekt av pasienter med alvorlig depresjon, rusmisbruk eller andre alvorlige psykiske lidelser ble ekskludert. Valg av studier: Alle relevante studier var systematisk og kritisk vurdert i forhold til definerte inklusjonskriterier og kvalitet. Primære utfallsmål var: depresjonssymptomer, psykososial funksjon, kvalitet av tjenester. Syntese av resultater: Narrativ syntese av resultater. Resultater: Åtte systematiske oversikter ble inkludert. Studiene var utført i andre helsesystemer enn de skandinaviske med overvekt av studier fra USA og England. Populasjonen inkluderte pasienter med lett til moderat depresjon og noen med alvorlig depresjon. Identifiserte modeller for samhandling: integrerte behandlingsprogrammer, opplæringstiltak, spesialister i allmennpraksis, rådgivning, case-management, samhandling om behandling. Overførbarhet av resultater fra studiene til skandinavisk setting er usikker. Det er behov for norske og skandinaviske studier. Kvalitativ forskning vil kunne belyse hvilke faktorer som fremmer eller hemmer samhandling i helsetjenesten. Konklusjon: • Samhandling i allmennpraksis mellom nivåene i helsetjenesten om voksne pasienter med depresjon synes å bedre kvaliteten av tjenester og behandlingsutfall for pasientene i større grad enn standard behandling. • Opplæringstiltak kombinert med psykiatrisk kompetanse i allmennpraksis og aktiv oppfølging synes mest effektive for pasienter med lett til moderat depresjon. • Evidensen er utilstrekkelig for en direkte sammenligning av klinisk effekt eller kostnadseffektivitet av de identifiserte modellene for samhandling. • Det er behov for mer forskning om hvilke pasienter som har mest nytte av samhandling og hvilke elementer av de sammensatte tiltak som har størst betydning for resultatet. / Objectives: To identify different models of collaborative care for mild to moderate depression in primary care settings and to evaluate their effectiveness. Method: Meta-review/ Overview of systematic reviews. Search: Medline, Cochrane Library, SWEMED, EMBASE and Cinahl database. Selection criteria: systematic reviews of controlled clinical trials of collaborative care in primary practice versus usual care for patients with mild to moderate depression. Exclusion criteria: Systematic reviews with majority of studies with patients with serious depression or other mental disorders or pure treatment studies. Data collection and analysis: All relevant studies published between 1995 and 2006 were systematically assessed for relevance and methodological quality. Primary outcomes were level of depression, psycho-social functioning and quality of care. The results are presented as a narrative synthesis. Results: Eight systematic reviews were included. Much of the evidence is based on studies performed in USA or UK. Patients with minor to moderate or even major depression were included. Interventions: educational tasks, counselling, disease management programmes, guidelines, managed care, case management, on-site specialist, shared care, active follow-up. It appears that complex interventions which include educative tasks towards guideline – based care combined with on-site specialist at primary care level improve both the quality of care and clinical outcomes compare to usual treatment. The evidence may not be directly applicable to a Nordic health care setting.There is a need for Nordic studies. Future studies would benefit from the addition of qualitative research about the conditions that facilitate or prevent collaboration in health care. Conclusion: • Collaborative service delivery in primary health care of patients with depression appears to be more effective intervention compare to usual care in terms of symptoms reduction, better adherence to treatment and psycho-social functioning and enhance quality of care. • Educative interventions combined with on-site specialist in primary care setting and active follow-up were the most frequent components of effective interventions. • The evidence is insufficient to provide a definitive answer to clinical effectiveness and cost-effectiveness of individual models or to make a comparison between models. • It is unclear which patients gain most profit from collaborative service delivery or which elements of complex interventions are most effective. We need more research. / <p>ISBN 978-91-85721-26-9</p>

This research proposes a framework for collaborative care in which the performance of healthcare teams is measured in an objective and quantifiable manner. We call our framework the Performance Management Framework for Collaborative Care (PMFCC). The PMFCC was developed using insights from agile software engineering, business, and healthcare and consists of three Components: the Collaboration Space Ontology Template, the Agile Process Model, and the Performance Management Model. We developed a set of example Artifacts based on our framework to better support performance management of collaborative care teams: Agile Treatment Plan, Agile Collaborative Dashboard, ICF Patient Card and Collaborative Care Model Canvas. The framework and associated Artifacts were developed iteratively using Design Science Research Methodology. Attention Deficit Hyperactivity Disorder was used as an example relevant to performance management of collaborative care teams. A Clinical Vignette drawn from the healthcare literature was used to develop a set of scenarios to test and evaluate the PMFCC and its Artifacts at each iteration. A panel of experts was established at the end of our research to review our results and provide structured and unstructured feedback based on a set of evaluation criteria drawn from the relevant academic literature. The PMFCC was also compared to related works from the literature.