Background: The COVID-19 pandemic dramatically shifted behavioral health (BH) service delivery from primarily in-person to telehealth services. Relationships and group processes, the crux of many BH services, may differ via telehealth. This impact is particularly relevant in rural communities, which are already at increased risk of poor health and BH outcomes. Disparities, poor internet/cell connectivity, and social isolation brought on by the pandemic exacerbate the risk for poor BH outcomes. Early estimates suggest that, while some engaged BH patients may increase utilization with telehealth, fewer patients overall are accessing services. It is vitally important to engage patients and providers from rural communities in articulating the impacts of this transition to telehealth as a new vision for the future of BH service delivery emerges.
Proposed Solution to the Problem: Finger Lakes Southern Tier IPA (FLST IPA), a network of BH providers, has deep relationships within the rural community, broad expertise with BH treatment services, and a shared mission to provide innovative services that meet the needs of vulnerable populations. FLST will leverage these attributes to engage stakeholders in learning collaboratives to articulate (a) the impacts (both positive and negative) of the shift to tele-behavioral health, and (b) how the rural community can partner with FLST IPA to design a sustainable service delivery model that meets their unique needs for BH services.
Objectives: Engage stakeholders in identifying unique needs/strengths of rural communities with BH needs, focusing on the impacts of the shift to telehealth and ideas for an ideal service model; collaboratively document areas of concern, local research priorities, educational needs, ways to support continued patient-centered partnerships around rural BH service delivery; develop/refine tools and resources for enhancing engagement of rural communities in research related to tele-behavioral health and the critical role of patient-provided data in driving effective patient-centered outcomes research and comparative clinical effectiveness research (PCOR/CER); disseminate resources via existing network, regional, and state meetings.
Activities: Patients, peers, and clinicians will be engaged in learning collaboratives to understand stakeholder perspectives, review and develop resources, and participate in dissemination of themes, ideas, and materials within the regional community.
Projected Outcomes and Outputs:
- Understanding the impacts of COVID-19 on BH services from stakeholders
- Developing tools, resources, and training materials for engaging rural stakeholders in the process of articulating impacts, needs, and a future PCOR/CER agenda
- Creating a bridge for future engagement of rural stakeholders in regional planning for innovative delivery models, advocacy efforts, and PCOR/CER
Current/recent patients and peers/clinicians from FLST IPA member agencies will be invited to participate in learning collaboratives. Following the learning collaboratives, participants will be invited to review summary materials and tools created and to co-present and/or attend regional dissemination forums to share project learnings. There are three primary ways in which stakeholders/patients will be connected to opportunities for participation in PCOR/CER on COVID-19 and other topics. First, FLST IPA, through the project team’s Quality and Clinical Integration Subcommittee, is frequently seeking interested patients and clinicians (since several are already in this group) to inform service delivery planning conversations, pilot programs, and project evaluation efforts. Interested stakeholders will have immediate opportunities to participate in this area and the team will actively recruit and engage these key stakeholders.
On a broader scale, FLPPS, through the DSRIP extension, is currently developing System Transformation and Community Investment projects with many partner agencies within the region. These projects must align with the triple aim and have ample opportunities to strengthen PCOR/CER principles in their design, implementation, and development if a cohort of stakeholders familiar with these principles and the research process is available.
Finally, within this region, there are many community groups seeking to improve the healthcare system that recognize that PCOR/CER is critical to sustainable change. Members of the core project team participate in many community panels and are frequently seeking patient and stakeholder involvement. Groups are cross-discipline, regional, and include a spectrum of individuals from career researchers from area hospitals to patient advocates. Some groups with which the current project team participates include those targeting COVID-19 vaccine distribution and understanding/addressing disparities therein, identifying community-level healthcare metrics, a countywide systems integration project, community-level adoption of a closed-loop referral system for social determinants of health care, and others. Building capacity within a stakeholder group with a strong voice for the needs and strengths of rural communities with behavioral health needs would be an incredible asset to this community, and the project team will readily foster connections to these groups in parallel to the current project.
Project Collaborators: Project participants will be invited from within the FLST IPA network. FLPPS will be engaged as a consultant to provide infrastructure support and project management, facilitate groups to maintain confidentiality for staff and patients, and engage regional leaders in dissemination forums.