# Presentation: 914155

## New Directions for the South Central MIRECCWhere Have We Been?Where Are We Going?

**Greer Sullivan, MD, MSPH**
**April 2008**

## Overview

**Review evolution through 2005**
**Describe key influences (2005-2007)**
**Outline new directions (2008 and onward)**

## Overview

**Review evolution through 2005**
**Describe key influences (2005-2007)**
**Outline new directions (2008 and onward)**

## Evolution

**1997**
**1998**

**  ****Submitted first MIRECC application**
**  ****First three MIRECCs approved – VISN 1, 20, 22**

**  ****Resubmitted VISN 16 application**

** ****VISN-wide**
** “****Virtual” center**
** ****Four anchor sites**
**	****(Houston, Little Rock, Jackson, New Orleans)**
** ****Report to VISN Director**

** ****SC**** MIRECC funded February 1998**

**Evolution**

** ****Second set of MIRECCs funded – VISN 3, 16, 22**

## Evolution

## Evolution

**  ****Key Programs Initiated**

** ****Research**

**  ****Basic Science, Clinical, Services**
**  ****Teams: PTSD, Schizophrenia, Substance Use,**
**   ****Geropsychiatry**
** ****Theme:  Psychopharmacology, family issues,**
**   ****neuroimaging**

** ****Visited all sites**

**  ****Newsletter (Communiqué)**
**  ****Clinical Educator Grants Program**
**  ****Research Pilot Study Program**
**  ****Annual Retreat**

**Evolution**

## EvolutionFirst External Review - 2000

**Strengths:**
**Suggestions:**
**Responses:**
**	**

**  ****network-wide involvement**
**  ****education programs**
**  ****link with MH product line**
**  ****focus! focus! focus!**
**  ****only initiate projects when you have strong leaders**
**  ****evaluate educational programs**
**  ****more consumer involvement**
**  ****pruning (basic science, substance abuse)**
**  ****seeking evaluation expertise**
**  ****discussing CAB formation**

## Evolution

**2001-3   Initiated Additional Programs**

** ****MIRECC Fellowship Program**
-  **Consumer Advisory Board**
** ****Clinical Partnership Program**
** ****Training Residents in Psychiatric**
** ****Scholarship (TRIPS)**
** ****Grant Writing Scholars Program**

## EvolutionSecond External Review - 2003

**  ****education and clinical care outstanding**
**  ****need to strengthen research**
**  ****strong leadership**
**  ****more evaluation of programs**
**  ****approaches to strengthen research and **
**     ****productivity**
**  ****telementoring**
**  ****strengthened evaluation resources**
**  ****reached out to departments for researchers**
**  ****started mentoring program**

**Strengths:**

**Suggestions:**

**Responses:**

## Administration

**Administration**
**Sullivan (LR)**
**Nasrallah (JK)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Sullivan (LR)**

**Vasterling (NO)**

## Administration

**Administration**
**Sullivan (LR)**
**Nasrallah (JK)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Henderson (LR)**

**Vasterling (NO)**

## Administration

**Administration**
**Sullivan (LR)**
**Nasrallah (JK)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Henderson (LR)**

**Vasterling (NO)**

**Clinical Care**
**Kotrla (HO)**

## Administration

**Administration**
**Sullivan (LR)**
**Nasrallah (JK)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Henderson (LR)**

**Vasterling (NO)**

**Clinical Care**
**Kotrla (HO)**

**Consumer**
**Advisory**
**Board**

## Administration

**Administration**
**Sullivan (LR)**
**Nasrallah (JK)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Henderson (LR)**

**Vasterling (NO)**

**Clinical Care**
**Kirchner (LR)**

**Consumer**
**Advisory**
**Board**

## Administration

**Administration**
**Sullivan (LR)**
**Kauth (NO)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Henderson (LR)**

**Vasterling (NO)**

**Clinical Care**
**Kirchner (LR)**

**Consumer**
**Advisory**
**Board**

## Administration

**Administration**
**Sullivan (LR)**
**Kauth (NO)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Henderson (LR)**

**Vasterling (NO)**

**Clinical **
**Care**
**Kirchner (LR)**

**Consumer**
**Advisory**
**Board**

**Research**
**Training**
**Kunik (HO)**

## Administration

**Administration**
**Sullivan (LR)**
**Kauth (NO)**

**Research**

**Education**
**Kauth (NO)**

**MHPL**

**Henderson (LR)**

**Vasterling (NO)**

**Clinical **
**Care**
**Kirchner (LR)**

**Consumer**
**Advisory**
**Board**

**Research**
**Training**
**Kunik (HN)**

**Pilot Study Program**

**Clinical Edu. Program**

**Fellowship**
**TRIPS**

**Clinical Dem. Program**

## EvolutionFive Year Renewal - 2005

** “****leading the way” among MIRECC’s**
** “****captures spirit and intent of MIRECC legislation”**
** “****hard not to love this group”**
** ****strong effort to “grow” research (TRIPS, fellowship, **** mentoring)**
** ****education very strong**
** ****consumer involvement good**
** ****excellent relationship with PLAC**
** ****self-evaluation = “model system”**

## Overview

**Review evolution through 2005**
**Describe key influences (2005-2007)**
**Outline new directions (2008 and onward)**

## Key Influences

** ****Hurricanes**
** ****MIRECC audit**
** ****Additional funds available for**** mental health clinical care**
** ****Changes in management culture**
**      ****at VACO**
** **

## Hurricanes! 

## Hurricanes

- Loss of New Orleans facility and Gulfport division
- Reconfiguration of MH care
- Hardships on patients and families
- SC MIRECC
- Great disruption!
- Kauth moves to Houston
- Loss of Vasterling
- Loss of other key New Orleans faculty
- Unfinished MIRECC projects

## SC MIRECC Audit

**Completely appropriate use of funds**
**Kudos to Debbie Hadsel!**
**“****Carry forward” not permitted**
**“****Commit” funds for specific projects**
**Results**
**Cannot accumulate discretionary funds**
**No more large pots of $$s**

## Increase in Funding for Mental Health Clinical Care

**$30 million to VISN 16**
**New programs, expansions of programs**
**Returning veterans**
**Family education and therapy**
**Expanding PTSD, SUD services**
**Mental health in CBOCs**
**Clinical services: Recruit! Recruit! Recruit!**
**National EBP training programs (CPT, rehab)**

## SC MIRECC Funds to VISN 16 Mental Health 

**Total****	****	****	****	****	****	****$3,623,000**
**Research pilot studies****	****	****$1,938,000**
**Clinical educators program****	****$   215,000**
**Clinical partnership program****	****$1,070,000**
**Network clinical training****	****	****$   400,000**
**About 17% of total $$**
**All sites received some $$**

## Increase in MH Funds + Decrease in MIRECC Funds

**MIRECC Funds**

**MH Clinical**
**Funds**

**2005**

**2008**

## Management Culture at VACO Much More Directive

**MIRECCs report to Dr. Katz**
**MIRECC budgets reviewed by line item**
**MIRECC budgets reduced and capped**
**Large-scale EBP training responsibility of VACO **
**Uniform Service Package**
**VACO under scrutiny**

## Required Review of SC MIRECC (0ctober 2007)

**Feedback**
**Focus too broad**
**Narrow focus:  rural, access, implementation**
**Research most important **
**Research accomplishments not always attributable to MIRECC**
**Required plan for “new MIRECC direction”**

## Response by MIRECC Leadership

**Mini Retreat: November 2007 **
**New mission statement**
**Recruited new Associate Director for Research (John Fortney)**
**Submitted plan + budget for rural survey**
**    ****(not funded)**
**Submitted plan for program shifts**
**Additional recruitment (Teale, Freund)**
**Survey of CBOCs**
**Re-review late 2008**

## Overview

**Review evolution through 2005**
**Describe key influences (2005-2007)**
**Outline new directions (2008 and onward)**

## Old Mission Statement

- To **close the gap** between efficacy (what we know that mental health treatments have the potential to do) and effectiveness (what mental health services actually accomplish in everyday VA care) for persons with mental disorders in the South Central VA Health Care Network (SCVAHCN) and nationally

## New Mission Statement

- To improve access to evidence-based practices in **rural and other underserved populations**, especially returning war veterans, veterans experiencing natural disasters, and vulnerable elderly veterans

## Implications for SC MIRECC Management

_**Bottom Up**_
**Pilot Study Program**
**Clinical Educator Grants**

_**Top Down**_
**Hurricane Study**
**Training in CBT**

## Implications for SC MIRECC Management 

**Research**
**More focused and directive**
**New organization, funding approach**
**Education**
**Directly related to new mission**
**More coordinated with research efforts**
**Clinical Care**
**Still focused on unique VISN 16 population **
**Emphasis on rural: CBOCs, returning veterans**

## Research Organization 

**Organize around sites**
**Site teams: leaders and site-specific themes**
**New Orleans: ****trauma**
**Oklahoma City: ****education \ support of families & caregivers**
**Jackson: ****distance technologies**
**Little Rock: ****partnering with communities**
**Houston:  ****two themes?**** **

## Research Funding

**Research funding flows to teams**
**Teams consult with “program officers”**
**Observational:  Fischer**
**Intervention:  Kunik**
**Implementation:  Kirchner**
**More directive (RFPs, SDRs) but some balance of investigator-initiated**
**Examples of SD projects: CBOC survey,          Hurricane study**

## Conclusions

**Ten years of very successful SC MIRECC program – celebrate!**
**Changes in response to direction from VACO ****(narrower focus, more directive)**
**Moving in a very positive direction**
**Better care for VISN 16 veterans**
**“****Brand” our MIRECC as “rural”**
**Increase research productivity**

## Thank You