Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Pat Deegan PHD & Associates, LLC

Name of Innovative Program: 
CommonGround
Sponsoring Organization
Pat Deegan PHD & Associates, LLC
Name of Innovative Program Lead: 
Patricia E. Deegan
E-mail Address of Innovative Program Lead: 
patricia.deegan@patdeegan.com
Project Description: 
Our premier web application is called CommonGround and it is being used in 21 clinics across Pennsylvania. Our proposition is that in the modern behavioral healthcare environment there is no time for waiting in clinic waiting rooms. In order to make the most of a 15-minute medication visit with a clinician, we need to get prepared to participate and collaborate with our doctors in making the best decisions for our treatment and recovery.  We help behavioral health organizations convert waiting rooms into Decision Support Centers (DSC's).  DSC's are run by paid peer staff who themselves are people in recovery.  Peer staff help people use the CommonGround web application to prepare a 1-page Health Report for use during the medication appointment. People use the CommonGround web application each time they come to medication clinic.  Even people with low literacy and no computer skills can use the interactive touch screens.https://www.patdeegan.com/
Creativity and Innovation: 
We are in an historic window of opportunity.  Clinical workflows for behavioral health practitioners are being hard-coded into electronic health records (EHRs).  EHRs are being designed with almost no input from those of us with diagnoses. Those of us with diagnoses are the other 50% of the healthcare equation. Patient portals with simplistic scheduling apps simply do not meet higher standards for meaningful use, person centered care and shared decision making.  As far as we know, we are the only group of patients in recovery who are actually engineering and implementing web applications that reflect what we need and want in an EHR. CommonGround is not just an innovation; it's a disruptive innovation that is bringing recovery, empowerment and the voice of the "patient" to the center of the clinical care team. 
Leadership: 
We are leading the way in designing and implementing web applications that help to empower and activate people with diagnoses to fully participate in treatment and recovery.  We have developed a method that allows people with low health literacy, low literacy and low computer literacy to effectively use a web application to prepare to participate in working with psychiatrists to make the best choices for treatment and recovery.  We consider our technologies to be assistive technologies.  Everyone gets nervous before doctors appointments.  But imagine having a mood or thought disorder to contend with as well!  9 out of 10 CommonGround users, use the web application at each visit.  CommonGround is assistive technology because it helps people organize their thoughts, and the computer does the job of pulling it all together in a concise 1-page report that can be quickly reviewed by the practitioner.  
Sustainability: 
We have a documented record of successful implementations of CommonGround in a variety of organizations, including managed care companies, universities, state mental health authorities, large multi-state/multi-site organizations and local non-profit service providers. A small number of organizations have started to use CommonGround, and cancelled the contract with us.  These organizations often did not spend enough time calculating the reimbursement of peer staff salaries in their planning.  However, the majority of CommonGround sites remain in operation.  Our data for September 2012 indicate that we currently have nearly 12,000 users and the rate at which shared decisions are entered is 60% across all sites.  This is extraordinary given the fact that the main barrier to shared decision making cited by physicians, are time constraints.  All of our CommonGround sites are in public domain behavioral health services that rely on 15 minute med visits. 
Replicability: 
CommonGround can be replicated.  It is now being used in approximately 50 behavioral health settings including sub-acute inpatient, a state hospital, Assertive Community Treatment teams (ACT), a substance abuse clinics, peer centers, and mental health centers.  We have developed a train-the-trainer model of implementation and also use the IHI Learning Collaborative Model for Improvement to replicate the program.  We have never accepted venture capital and have bootstrapped the CommonGround innovation in order to remain in control of the innovation and to keep it person centered and recovery oriented.  However, we have had some great partners and early adopters.  These organizations believe in our work and have contracted with us to expand CommonGround.  Community Care Behavioral Health in PA, now has 12 sites and 4 more in development.  Community Behavioral in Philadelphia has been an early adopter of our technology. 
Results/Outcomes: 
According to third party research, CommonGround helps to activate and engage people with their treatment and helps to re-engineer the discourse between psychiatrists and patients so the conversation focuses on lifestyle modifications to improve overall health and wellness. There are currently nearly 12,000 users who complete Health Reports at 9 out of 10 visits.  Physicians using CommonGround enter shared decisions about the next steps in treatment 60% of the time across all clinics.  Some rates of documented shared decisions at clinics are as high as 90%.  In December 2012, SAMHSA is convening a meeting to discuss research approaches to shared decision making, including CommonGround.  We have a research agreement with the Dartmouth Psychiatric Research Center and the Center for Technology in Behavioral Health.  We are using both qualitative and quantitative, quasi experimental approaches to study it.  The University of Kansas has received an NIMH grant to study CommonGround implementation.
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