Abstract for:Effectiveness of Modeling as a Health System Intervention for Addiction and Mental Health Service Improvement

For 15 years the Veterans Health Administration has trained providers in evidence-based addiction and mental health care and mandated evidence-based practices (EBPs). Yet, only 3-28% of the patient population receives the highest quality care. Limited EBP reach among the patient population is our primary system behavior and modeling problem. However, it is understanding causes of limited EBP reach in local clinics that is critical to VHA policy-makers, patients, and providers. Therefore, we sought to empower frontline teams making EBP-related care decisions to achieve local improvement. Our partnership with stakeholders developed five simulation models designed to lead to insights over a series of twelve typical one-hour team meetings. Models address problems with care coordination, medication management, psychotherapy, aggregate service mix, and measurement-based stepped care for suicide prevention. Facilitation guides, and data and simulation user interfaces make team trends, and causal dynamics of EBP reach transparent for facilitating team’s double-loop learning at national scale (Sterman, 2000; Sterman, 2006).  Statistical process control analyses indicate participating clinics demonstrated a three standard deviation increase in EBP reach, and maintained improvement for 12 and 8 months respectively. Our program, Modeling to Learn, is accredited for licensure and rolling out nationally in VHA in 2019.