Integrating Behavioral Health & Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation

New Hampshire residents face challenges with behavioral and physical health conditions and the interplay between them. National studies show the costs and the burden of illness from behavioral health conditions and co-occurring chronic health conditions that are not adequately treated in either primary care or behavioral health settings. Bringing primary health and behavioral health care together in integrated care settings can improve outcomes for both behavioral and physical health conditions. Primary care integrated behavioral health works in conjunction with specialty behavioral health providers, expanding capacity, improving access, and jointly managing the care of patients with higher levels of acuity In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative (Initiative) created the NH Behavioral Health Integration Learning Collaborative (BHI Learning Collaborative) in November of 2015, as a project of its Accountable Care Learning Network (NHACLN). Bringing together more than 60 organizations, including providers of all types and sizes, all of the state’s community mental health centers, all of the major private and public insurers, and government and other stakeholders, the BHI Learning Collaborative built on earlier work of a NHACLN Workgroup focused on improving care for depression and co-occurring chronic illness. The BHI Learning Collaborative design is based on the core NHACLN philosophy of “shared data and shared learning” and the importance of transparency and open conversation across all stakeholder groups. The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service (FFS) revenues. Provider members joined either a Project Implementation Track working on quality improvement projects to improve their levels of integration or a Listen and Learn Track for those just learning about Behavioral Health Integration (BHI). Providers in the Project Implementation Track completed a self-assessment of levels of BHI in their practice settings and committed to submit EHR-based clinical process and outcomes data to track performance on specified measures. All providers received access to unblinded NHACLN Primary Care and Behavioral Health attributed claims data from the NHCHIS for provider organizations in the NH BHI Learning Collaborative. Following up on prior work focused on developing a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings, the BHI Learning Collaborative engaged consulting experts and participants in understanding challenges in Health Information Technology and Exchange (HIT/HIE), privacy and confidentiality, and workforce adequacy. The BHI Learning Collaborative identified a sustainable payment model for integrated care of depression in primary care. In the process of vetting the payment model, the BHI Learning Collaborative also identified and explored challenges in payment for Substance Use Disorder Screening, Brief Intervention and Referral to Treatment (SBIRT). New Hampshire’s residents will benefit from a health care system where primary care and behavioral health are integrated to support the care of the whole person. New Hampshire’s current opiate epidemic accentuates the need for better screening for behavioral health issues, prevention, and treatment referral integrated into primary care. New Hampshire providers and payers are poised to move towards greater integration of behavioral health and primary care and the Initiative looks forward to continuing to support progress in supporting a path to sustainable integrated behavioral and primary care

An Exploration of Models for Collaborative Leadership of Virtual Learning Network e-Learning Clusters in New Zealand

Faced with the massive challenge of personalising learning for a digital generation, educators need to change. Collaboration and collaborative leadership, having been widely researched and implemented, are now considered to be strategic components of systemic transformation. Many jurisdictions have trialled or instituted collaborative or cluster-based projects to address the collaborative learning and leadership challenges associated with transformation through e-learning. New Zealand’s emergent Virtual Learning Network and e-learning clusters have developed new system leadership from grass-roots rural schools with the Ministry of Education’s strategic support. Can these innovative collaborative projects continue to improve and sustainably contribute to educational transformation in NZ? This small-scale qualitative investigation focussed on semi-structured interviews to gather data from five experienced rural cluster Lead Principals who have successfully lead some of the stronger rural Virtual Learning Network e-learning clusters across rural New Zealand. The key research question which guided the interview questions and analysis was: What are the most appropriate and effective models for managing and leading collaborative relationships and shared long-term projects for clusters of secondary schools? The aim was to discover the conceptions and use of collaborative processes, structures and leadership which theoretical and empirical research suggest are critical components of system-wide reform. Research findings reveal a high degree of congruence between theory and the practice of these five Lead Principals. Their understanding and practice of shared, distributive and collaborative leadership, with a clear commitment to building leadership capacity, was based more upon their personal style supported by some knowledge of the international literature, rather than formal policies. However, while these maturing clusters have outlasted many others, they continue to face challenges of viability, effectiveness, and sustainability, in spite of the Ministry of Education’s support for critical background infrastructure. The data shows that while there are strong collaborative support strategies in and for these clusters, two key areas could be addressed more effectively. This study suggests that collaborative transparency and accountability needs strengthening in a drive for consistent quality and effectiveness. Also, while new structural cluster models may be emerging in the search for sustainability, the well-established cost of managing collaborations has not yet been accepted by the MoE, leaving 100% of the burden of management costs on the mostly small rural schools. It is therefore recommended that the MoE find a way around the current school-based funding model to at least partially fund regional management of these transformative collaborations, perhaps within the government’s current drive to build performance management and accountability. New Zealand’s systemic transformation and its current leadership within the e-learning revolution may depend on it

Mind Mapping: A Strategy to Promote Interprofessional Collaboration among Health Science Students

Purpose/Background: This presentation will provide participants with an understanding of what mind mapping is and engage participants in a discussion and hands on experience of how mind mapping can be used to prepare students for interprofessional collaborative practice and integrate patient centered models of care. Managing a patient’s plan of care requires health care practitioners to share and integrate data in order to formulate a plan of care. How to engage with other disciplines is often developed during student’s clinical educational experiences. Assisting and engaging students during the academic portion are essential to prepare them for interprofessional collaborative practice. Mind Mapping is an innovative instructional strategy which focuses on integrating information using a 360 non-linear approach. Mind maps require learners to think not only in a curvilinear manner but also use visuospatial relationships which flow from a central concept. For students, using this 360 approach to explore and connect concepts and themes a rich environment for content integration emerges. Mind mapping is emerging as a positive teaching and learning strategy for health science students however there has been limited evidence supporting its efficacy in interprofessional education. Descriptions of Program Mind mapping can be infused at several points within an interprofessional curriculum. Faculty can model for students their own integration of knowledge by creating and sharing their mind maps. Alternately, IPE student groups can create mind maps and thereby engage in self-directed active learning. These options provide rich experiences for students to work on integrating content knowledge across disciplines for the development of robust interprofessional patient-centered care. Preliminary Result on Mind Mapping used in an interprofessional curriculum as well as students’ perceptions will be shared. Conclusion /Relevance to interprofessional education or practice Using a mind maps non-linear approach to learning provides may further aid student’s ability to critically reflect upon and analyze the necessary information, to develop and modify a patient’s interprofessional plan of care. This model of infusion of mind maps can be utilized in interprofessional curricular to prepare students for collaborative practice. Learning Objectives: Participants will be able to: describe the tenets associated with the development of a mind map for IPE discuss a model of infusion of mind maps for interprofessional education and collaborations recognize how to integrate mind maps into their interprofessional curricular model

AfL with APP: developing collaborative school-based approaches: guidance for senior leaders (National Strategies)

"Schools are now taking forward Assessing Pupils' Progress (APP) as a continuing priority to personalise learning for all pupils across all phases, plan for progression and overcome barriers. This document brings together a range of key published materials for the first time. It provides quality standards to enable schools to evaluate the progress they have made together and plan further development, offers information on arrangements for school to school support and a summary of collaborative approaches such as lesson study. For many schools, development of Assessment for Learning (AfL) with APP now depends on the emergence and sharing of excellent school-based work to generate sustainable improvement. This publication is consequently of particular relevance to headteachers, senior management teams and subject leaders/curriculum coordinators as they plan and develop effective partnerships for APP." - National Strategies website

Collaborative Authoring of Adaptive Educational Hypermedia by Enriching a Semantic Wiki’s Output

This research is concerned with harnessing collaborative approaches for the authoring of Adaptive Educational Hypermedia (AEH) systems. It involves the enhancement of Semantic Wikis with pedagogy aware features to this end. There are many challenges in understanding how communities of interest can efficiently collaborate for learning content authoring, in introducing pedagogy to the developed knowledge models and in specifying user models for efficient delivery of AEH systems. The contribution of this work will be the development of a model of collaborative authoring which includes domain specification, content elicitation, and definition of pedagogic approach. The proposed model will be implemented in a prototype AEH authoring system that will be tested and evaluated in a formal education context

Outcomes from collaborative provision audit: frameworks, guidance and formal agreements

The reports on Collaborative provision audits conducted between 2005 and 2007 indicate that, in general, the frameworks established by institutions for the management of quality and academic standards in their collaborative provision are sound and effective. Nevertheless, most reports provided advice on how particular aspects of the frameworks might be improved. The reports describe the various models or types of collaboration undertaken by institutions, and the relationships between these and the quality management arrangements employed. Recommendations in this context focused on the need for clarity in the use of terms and their procedural implications. Particular difficulties were associated with accreditation agreements in a number of institutions. The reports' consideration of formal agreements between awarding and partner institutions suggests several recurring themes, including: the relationship between types of collaboration and the contracted arrangements and responsibilities; the relationship between institutional and programme elements in agreements; arrangements for the review and renewal of agreements; and the need for ratification of agreements prior to the operation of programmes. The guidance provided on frameworks and processes for managing quality and standards in collaborative provision emerged as a widespread strength in awarding institutions and was linked with numerous features of good practice

Exploiting tacit knowledge through knowledge management technologies

The purpose of this paper is to examine the contributions and suitability of the available knowledge management (KM) technologies, including the Web 2.0 for exploiting tacit knowledge. It proposes an integrated framework for extracting tacit knowledge in organisations, which includes Web 2.0 technologies, KM tools, organisational learning (OL) and Community of Practice (CoP). It reviews a comprehensive literature covering overview of KM theories, KM technologies and OL and identifies the current state of knowledge relating to tacit knowledge exploitation. The outcomes of the paper indicate that Internet and Web 2.0 technologies have stunning prospects for creating learning communities where tacit knowledge can be extracted from people. The author recommends that organisations should design procedures and embed them in their Web 2.0 collaborative platforms persuading employees to record their ideas and share them with other members. It is also recommended that no idea should be taken for granted in a learning community where tacit knowledge exploitation is pursued. It is envisaged that future research should adopt empirical approach involving Complex Adaptive Model for Tacit Knowledge Exploitation (CAMTaKE) and the Theory of Deferred Action in examining the effectiveness of KM technologies including Web 2.0 tools for tacit knowledge exploitation

Try, try again: Lessons learned from success and failure in participatory modeling

Participatory Modeling (PM) is becoming increasingly common in environmental planning and conservation, due in part to advances in cyberinfrastructure as well as to greater recognition of the importance of engaging a diverse array of stakeholders in decision making. We provide lessons learned, based on over 200 years of the authors' cumulative and diverse experience, about PM processes. These include successful and, perhaps more importantly, not-so-successful trials. Our collective interdisciplinary background has supported the development, testing, and evaluation of a rich range of collaborative modeling approaches. We share here what we have learned as a community of participatory modelers, within three categories of reflection: a) lessons learned about participatory modelers; b) lessons learned about the context of collaboration; and c) lessons learned about the PM process. First, successful PM teams encompass a variety of skills beyond modeling expertise. Skills include: effective relationship-building, openness to learn from local experts, awareness of personal motivations and biases, and ability to translate discussions into models and to assess success. Second, the context for collaboration necessitates a culturally appropriate process for knowledge generation and use, for involvement of community co-leads, and for understanding group power dynamics that might influence how people from different backgrounds interact. Finally, knowing when to use PM and when not to, managing expectations, and effectively and equitably addressing conflicts is essential. Managing the participation process in PM is as important as managing the model building process. We recommend that PM teams consider what skills are present within a team, while ensuring inclusive creative space for collaborative exploration and learning supported by simple yet relevant models. With a realistic view of what it entails, PM can be a powerful approach that builds collective knowledge and social capital, thus helping communities to take charge of their future and address complex social and environmental problems