Learning Collaboratives for Quality Improvement and Implementation in Behavioral Health
What’s the Question?
Learning collaboratives are increasingly used in behavioral health to improve the quality and effectiveness of care. They generally involve bringing together teams from different organizations and using experts to educate and coach those teams in quality improvement, use of evidence-based practices, and evaluation. Sharing of strategies, data, successes, and obstacles among participating teams is central to the approach.
With the proliferation of learning collaboratives, though, has come wide variability in how they are conducted. Technical assistance (TA) providers may be unclear about which components are the most important, how long a learning collaborative should last, and when a learning collaborative is the right approach in the first place.
In particular, there hasn’t been much research done on the use of learning collaboratives in behavioral health care. This commentary article stems from a project led by the Annapolis Coalition on the Behavioral Health Workforce for the Mental Health Technology Transfer Center Network to improve knowledge about collaboratives within the behavioral health community and to promote, if warranted, an increase in their use across the country.
How Was This Project Conducted?
The authors reviewed scientific papers and other sources about the use of learning collaboratives and also interviewed key experts in the field in an attempt to clarify the concept of a learning collaborative, highlight its common elements, review evidence of its effectiveness, identify its application in behavioral health, and highlight recommendations to guide TA and behavioral health providers in the use of learning collaboratives to improve access and quality of care.
What Did the Authors Find Out?
Based on their review of the literature and interviews with experts, the authors determined that the term “learning collaborative” is often used loosely as a label for efforts at quality improvement and implementation that are not well-defined or described. Though learning collaboratives often have numerous components, like in-person learning sessions, plan-study-do-act cycles, and data collection for quality improvement, research hasn’t examined the effectiveness of each element individually, so it’s unclear which parts of a traditional learning collaborative might be the most important.
At the end of this commentary piece, the authors make a variety of recommendations for organizations and TA providers who are interested in implementing a learning collaborative, and also stress the fact that health equity, a topic area they identify as of key importance for every health organization, remains one that has received little attention among learning collaboratives in either general health care or behavioral health settings.
Some of the recommendations include:
- emphasize diversity, equity, and inclusion
- include persons in recovery and family members in teams and the faculty
- prioritize peer-to-peer learning
- insist on engagement and participation early and do not allow passive participation
- generate enthusiasm about improving care
- prioritize in-person contacts when participants have no prior experience with learning collaboratives, agencies are mandated to participate, or participants are from different health sectors
- take advantage of virtual meetings to expand access to a larger number of agencies and staff
- use virtual small group breakouts to promote interpersonal relationships
- adopt an explicit model of improvement
- monitoring for learning collaborative completion and dropout rates
- focus collaboratives on behavioral health conditions that uniquely impact diverse communities
Find the complete list of recommendations on pages 269-260 of the paper (available for free online).
What Are the Implications for the Workforce?
The behavioral health field has yet to adequately bridge the enormous gaps in access to high-quality, effective treatment for mental health and substance use disorders, and this is especially true for diverse populations. Learning collaboratives have emerged as a frequently used strategy to help with these efforts.
While learning collaboratives are often viewed as a heavy lift, involving significant costs, time, and effort, less intensive training methods, like one-time workshops, are generally ineffective at creating sustained change. Though the evidence on the effectiveness of learning collaboratives is limited, technical assistance providers and behavioral health agencies should not shy away from this approach. Instead, they should draw inspiration and direction from the many high-quality examples of learning collaboratives that have been conducted in behavioral health and the wealth of educational and training resources that are available.