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Project Implementation Enhancing Referral Follow-Through for Veterans in Outpatient Mental Health Care

Beverly Jordan Herzing University NU 820 May 19, 2026

Project Implementation

The proposed Doctor of Nursing Practice (DNP) project intervention is designed to improve referral follow-through among veterans receiving outpatient mental health services at Mindful Health, a private outpatient behavioral health practice. The intervention focuses on implementing a structured psychiatric mental health nurse practitioner (PMHNP)-led referral coordination and follow-up process to address barriers that prevent veterans from successfully attending referred specialty appointments and supportive community services. Veterans diagnosed with mental health disorders frequently experience barriers such as transportation limitations, scheduling difficulties, poor communication, stigma, and fragmented coordination between providers, all of which contribute to missed referrals and delayed treatment. The intervention seeks to improve continuity of care and patient engagement through standardized referral tracking, patient education, reminder communication, and follow-up support (Kilbourne et al., 2021).

The intervention will be implemented over an eight-week period. Eligible participants will include adult veteran patients receiving outpatient mental health treatment who require referrals to specialty behavioral health, medical, or supportive community services. At the time of referral initiation, the PMHNP or designated staff member will provide verbal and written education regarding the purpose of the referral, the importance of referral completion, and available support resources. A standardized referral tracking tool will be utilized to document referral initiation dates, appointment scheduling status, attendance outcomes, and follow-up communication attempts. Patients will receive reminder phone calls or text messages within 48 to 72 hours before scheduled appointments. Additional follow-up contact will occur within one week after the scheduled referral appointment to determine whether the appointment was attended and to identify barriers interfering with referral completion. Research has demonstrated that care coordination and structured follow-up interventions improve treatment adherence and mental health outcomes among veterans and other vulnerable populations (Davis et al., 2022).

The intervention will also incorporate motivational interviewing techniques during patient encounters to strengthen engagement and encourage treatment adherence. Staff participating in the project will receive brief education regarding referral workflow processes, documentation expectations, and communication strategies to ensure consistency during implementation. Weekly monitoring of referral completion rates will be conducted to evaluate project progress and identify workflow concerns requiring adjustment. Outcome measures will include referral completion rates, missed referral appointments, patient-reported barriers, and patient satisfaction related to care coordination services. These measures will assist in determining whether the intervention improves continuity of care and referral adherence among the veteran population served at the practice. Evidence suggests that improving communication, patient engagement, and coordinated mental health services can reduce disparities in treatment participation and improve healthcare outcomes among veterans (Spoont et al., 2021).

Prior to implementation, the project will be submitted for Institutional Review Board (IRB) review to ensure ethical compliance and protection of patient rights. The project is expected to qualify as a quality improvement initiative and will likely meet criteria for exempt review because the intervention focuses on improving an existing clinical process without introducing experimental treatment. The IRB submission will include the project purpose, implementation procedures, data collection methods, confidentiality protections, and plans for secure storage of patient information. Participation in the project will remain voluntary, and all collected data will be de-identified to protect patient privacy and confidentiality in accordance with HIPAA regulations. Any modifications made during implementation will be documented and evaluated to determine their impact on project outcomes and workflow effectiveness.

References

Davis, L. L., Kyriakides, T. C., Suris, A. M., Ottomanelli, L. A., Mueller, L., Parker, P. E., & Resick, P. A. (2022). Effect of evidence-based psychotherapy and care coordination on mental health outcomes among veterans. Psychiatric Services, 73(4), 381–388.

Kilbourne, A. M., Beck, K., Spaeth-Rublee, B., Ramanuj, P., O’Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2021). Measuring and improving the quality of mental health care: A global perspective. World Psychiatry, 20(1), 30–38.

Spoont, M. R., Nelson, D. B., Murdoch, M., Sayer, N. A., Nugent, S., Rector, T., & Westermeyer, J. (2021). Are there racial/ethnic disparities in VA PTSD treatment retention? Depression and Anxiety, 38(2), 196–204.