HOME Program Wins VA Shark Tank Competition, Named “Gold Status” Program

One of the suicide-prevention programs funded by the MSRC has received the ultimate compliment: It has been chosen through a VA “shark tank” competition as an approach worthy of being adopted by VA centers beyond the ones where it was initially developed. Assuming that it continues to prove its worth, this could be the first step toward a widespread adoption of the program—known as the HOME program—throughout the VA system.

The HOME, or Home-Based Mental Health Evaluation, program was developed by Bridget Matarazzo and colleagues at the Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) as a way of creating a better transition between inpatient and outpatient care for Veterans who are at risk of suicide (see Improving the Inpatient-to-Outpatient Transition). The impetus for the program was the observation that for patients who are psychiatrically hospitalized, the first week after leaving the hospital is the most dangerous. Indeed, research has shown that in that weeks following hospitalization, the suicide rate among Veterans is five times the base rate. A large part of the problem, Matarazzo explains, is that the Veterans go from a stable, supportive environment in the hospital to one that can be uncertain and stressful, making the transition and the following weeks quite unsettling to many Veterans.

The HOME program is designed to ease this transition and provide help and guidance to Veterans in the weeks following discharge and bring them to a point where they are safely settled in to their post-hospitalization lives with a routine that provides a significant level of outpatient support. In a clinical demonstration project carried out at VA centers in Denver, Salt Lake City, and Durham, North Carolina, the HOME program was successful in getting Veterans to take advantage of available outpatient support services much more quickly and more regularly after leaving the hospital. This is important because it is the Veterans who fail to continue to see clinicians after leaving the hospital who are most at risk of suicide.

Given the success of the demonstration project, Matarazzo’s colleagues at the Durham VA entered HOME into the VA’s version of the television show “Shark Tank.” In the show, various groups describe their ideas for a business to a group of investors, who decide which of the ideas are worth investing in. In the VA’s version, created by the VA Under Secretary for Health, David Shulkin, over 400 different groups from VA centers around the country entered a competition designed to identify a group of innovations and improvements that were most worthy of being adopted by other parts of the VA system. The idea behind the competition was that with more than 1,700 VA sites around the country sharing many of the same challenges and issues, one way to improve care throughout the system would be to identify valuable innovations made in one site and spread them to others.

From the 453 entries, 20 finalists were chosen from 14 different regions. Each of the finalists created a two-minute video describing the innovation or improvement. Those finalists then had a shark tank competition in which each representative had two minutes to pitch their project to VA medical center leaders, who were the “sharks”. The sharks then had two minutes to ask questions about the project and then one minute to place “bids.”

“It was a very intense, but fun, five minutes,” Matarazzo said.

After the HOME program presentation, eight different VA facilities bid to reproduce the HOME program in their areas. Of those eight, the William Jennings Bryan Dorn VA Medical Center in Columbia, South Carolina, was chosen to get the first chance to institute the HOME program. The idea behind choosing just one, Matarazzo explained, is that the best way to spread each of these Shark Tank innovations will be to start with a single new location where it is given strong support to succeed and then use the lessons learned from implementing it in that one center to spread it elsewhere. The leaders at the Dorn medical center were very excited about the HOME program, Matarazzo says, and they assured her that they have everything needed to put it into action and that the program will have very strong leadership support there.

Of the 20 finalists in the Shark Tank competition, approximately one dozen were named as “gold status” practices to be implemented in other locations in this way. Matarazzo and the other leaders of the gold status practices have been named fellows and will play major roles in seeing that their projects are successfully put into practice in the other facilities. For Matarazzo and the MSRC it is a satisfying recognition of the value of the HOME program and of its potential to significantly improve the care of Veterans.

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