Community living center-mental health integration in the Veterans Health Administration: Evaluation of practice patterns

Abstract: Starting in 2008, the Veterans Health Administration required mental health (MH) provider integration in nursing homes, called Community Living Centers (CLCs), to promote access to quality MH services. This project aimed to understand MH practice patterns and service integration in the CLC and to identify facilitators and barriers to integrated MH services. CLC physician and nurse leaders, and MH providers, were invited to participate in national surveys in the fall of 2022. Survey questions were designed to assess MH provider staffing and workload, organizational alignment and resources, practice and services provided, training and resource needs, MH provider satisfaction and burnout, integration, and CLC team functioning and morale. Questions included structured and open-ended formats. A total of 107 CLC MH providers and 85 CLC leaders completed their respective surveys. Descriptive and bivariate analyses were performed with quantitative data, and conventional content analysis procedures were used to analyze open-ended text responses. Findings highlighted that CLC MH providers care for Veterans with complex presentations across a range of treating specialties requiring many specialized skills, and MH integration is important and valued by CLC leaders. Results support Veterans Administration MH integration efforts and highlight the need for and importance of MH services in the CLC. MH provider job satisfaction and burnout were significantly related to team functioning, morale, and support. Findings will inform ongoing development of CLC MH practice resources and serve as a baseline for further evaluation.

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