The Integration Train is Moving

1
The Integration Train is Moving Are You
Onboard? If Not, Learn How to Get Your Ticket!

• Presented by
• Mark A. Engelhardt, MS, MSW, ACSW
• Rick Hankey, MA
• Laureen Pagel, PhD, MS, CAP, CPP, CMHP
• Rita Chamberlain, MBA
• Kay Doughty, MA, CAP, CPP
• Phillip Brooks, LMHC

2
Learning Objectives

• Identify national, state and local models of
  behavioral healthcare and primary health
  integration
• Identify and describe the continuum of healthcare
  integration models
• Use the tools and tips provided to establish an
  integration action plan for beginning and/or
  enhancing integration efforts
• Self-assess where their organization stands on
  the integration continuum model.
• Leave with a list of contacts/resources
  pertaining to integration

3
Integrated Behavioral Health Primary
CareNational/State/Local Development

• FADAA/FCCMH Annual Pre-Conference
• Mark A. Engelhardt, MS, MSW, ACSW
• USF FMHI Dept. of Mental Health
• Law Policy

4
The Case for Integrated Care

• People with mental health and substance abuse
  disorders die 25 years earlier that the average
  person, mostly from untreated and preventable
  chronic illnesses like hypertension, diabetes,
  obesity and cardiovascular disease.
• Poor health habits, such as inadequate physical
  activity, nutrition, smoking and substance abuse
• Barriers to primary healthcare complex systems
• Solution Integrated behavioral (SAMH) and
  primary healthcare produces better outcomes for
  people with complex needs involved in multiple
  systems of care.
• Quality of Integrated Care Cost to Person/System

5
Organizational Support (2003-14)

• World Health Organization
• Substance Abuse and Mental Health Service
  Administration (SAMHSA)
• Health Resources Services Administration (HRSA)
• National Council for Behavioral Healthcare
  Community Mental Health Centers and Integrated
  Substance Abuse Providers
• Community Health Centers Federally Qualified
  Health Centers (FQHCs)
• Health Behavioral Healthcare Advocates

6
Four Quadrant Model

• Population Based (NCCBH)
• Population with low to moderate risk/complexity
  for both behavioral and physical health issues
• High Behavioral health risk/complexity and low to
  moderate physical health risk/complexity
• Low to moderate behavioral health risk/complexity
  and high physical health risk/complexity
• High risk and complexity for both behavioral and
  physical health ( SAMHSA HRSA Grant focus)

7
Integration Models (A Few)

• Primary Care in Behavioral Health Settings
  Behavioral Health in Primary Care Settings or
  Bi-Directional
• Patient-Centered Health Homes (Approach, Not a
  Physical setting) Integrated Treatment Planning
• Chronic Care Disease Management Models
• Improving Mood Promoting Access to
  Collaborative Treatment IMPACT Early
  Evidenced-based
• Cherokee Health Systems Fully Integrated
  (Tenn.)
• Range Coordinated Co-Located Integrated
  More on Slide 13 with Hand out Afternoon
  discussion

8
SAMHSA HRSA Solutions

• Target People with Serious Mental Illnesses
• 100 Current SAMHSA-HRSA Primary Behavioral Health
  Care Integration grants
• Center for Integrated Health Solutions National
  Technical Assistance
• http//www.integration.samhsa.gov
• Supplemental Health Information Technology (HIT)
  One Year Grants to supports the development of
  Electronic Health Records (EHR) with grantees
• New PBHCI Grant applications to be awarded in
  2015?

9
Southeast Learning Community

• Seven (7) Florida Grantees
• Apalachee Center Tallahassee
• Coastal Behavioral Healthcare Sarasota
• Lakeside Behavioral Healthcare Orlando
• Lifestream Behavioral Healthcare Leesburg
• Henderson BH (V)

• Miami Behavioral Health Center Miami
• Community Rehabilitation Center Jacksonville
• 7 Others in HHS Region
• Georgia 3 Community Service Boards
• 4 Kentucky (I) S.C. State DMH NC TN (V)
• Cohorts I V (2009-14)

10
National Outcome Measures

• Functioning Wellness Healthy Overall
• Functioning in Everyday Life
• No Serious psychological distress -
• Using Illegal Substances
• Not binge drinking
• Retained in the community

• Housing Stability
• Education and Employment
• Criminal Justice Involvement
• Perception of Care
• Social Connectedness
• Positive outcomes overall
• Rand Evaluation

11
At Risk Criteria Tracking TRAC

• Blood Pressure (130/85)
• Body Mass Index (Greater of equal to 25)
• Waist Circumference (Male 102cm Female 88 cm)
• Breath CO ( Greater than or equal to 10)
• Fasting Plasma Glucose ( Greater than 100)
• Cholesterol (HDL less than 40 LDL, Greater than
  or equal to 130 Triglycerides, Greater than or
  equal to 150
• The big one SMOKING

12
Rand Research Questions

• Process Evaluation Is it possible to integrate
  Primary and Community-based Behavioral Health
  agencies? Structural and clinical approaches
• Outcomes Does integration lead to improvement
  of in SAMH and health of a population of
  individuals with serious mental illnesses (
  co-occurring)
• Model Features Which models or features of
  integration lead to better SAMH and Healthcare
• National data (NOMS and TRAC) - Progress

13
Grantee Evaluation Rand Corp.

• 56 Grantees included in the National Evaluation
• 67 Partnered with FQHCs
• Over 16,000 served since 10/1/09 -2012
• Outcome (Data), Process and Model Evaluation
• 78 of Grantees are urban programs in 26 states
• Use of Evidenced-based practices
• Challenges - Data, recruiting staff and
  consumers, licensing, info-sharing
• 1 arrested in past 30 days 63 in stable housing

14
Rand Corporation Report

• Early Programs SAMH in Health Care Settings
• Now Primary Care in SAMH Settings
• Common Features
• Embedded Nurse, On-site Physician, Health
  Screenings, Illness Management Recovery
  Programs Wellness Recovery Action Plans
  Screening Brief Intervention- Referral to Tx
  (SBRIT) Peer Specialists Case management
• Diverse Models Clinic Based to Home visits

15
Levels of Integrated Healthcare

• Coordinated Key element Communication
  usually minimal to basic coordination
• Co-located Key Physical Proximity usually
  basic to close collaboration on-site
• Integrated Key Practices Change usually
  close collaboration to a fully transformed/merged
  integrated practices Clients experience a
  seamless response to all of their health and
  behavioral healthcare needs
• Heath, Wise Reynolds March 2013 (CIHS)
• HAND OUT

16
Workforce Issues

• Peer Support Specialists
• Shared Decision Making Person Driven
• Nursing Physicians Assistants
• Access to Psychiatry Outpatient SAMH Treatment
• Training On-line, Certificate Programs (UMASS)
  Numerous Webinars Cross-training among
  disciplines, attitudinal changes case and care
  management models Recovery-oriented care
• Recruitment and retention (Future Medicaid
  Expansion and Affordable Care Act)
• Cultural proficiency

17
Clinical Considerations

• Screening Tools ( I.E. SBIRT Screening, Brief
  Intervention Referral to Treatment)
• Health Indicators ( Substance use, tobacco, blood
  pressure, cholesterol, weight, nutrition, etc.)
• Motivational Interviewing
• Medication Assisted Treatment Pharmacology
• Pain Management (Agency Policies)
• Trauma Informed Care
• Targeted Populations

18
PBHCI Programs

• Million Heart Campaign National HHS campaign to
  prevent 1 Million heart attacks strokes in 5
  years
• Wellness programs Strategies Education,
  healthy eating, physical activity, stress
  management, recovery processes, peer support,
  diabetes management, etc.
• Tobacco cessation (I.E., Univ. of Colorado)
• Substance abuse prevention/relapse
• Targeted populations homeless, drop-in centers,
  housing is healthcare, in-vivo.
• Interns , students, volunteers, existing programs

19
Administration Operations

• Memorandum of Understanding with partners (I.E.
  FQHCs) Array of services who will provide
  what?
• Contracts and formal agreements Partners
• Clarify Billing Opportunities and Revenue Sources
  Grants, Medicaid, Medicare, Physical Health
  Behavioral Healthcare Now Future (Affordable
  Healthcare Act Prospective)
• Health Information Technology Electronic Health
  Records Confidentiality Integration
• Meaningful Use Data Analysis

20
Organization Readiness

• Are you providing Primary Healthcare? If so, is
  it a Bi-directional On-site Off-site Service?
• Do you have signed contracts with FQHCs, County
  Health Departments, Medicaid Managed Care Plans
  (I.E. Magellan, HMOs) or Private Funding Panels
• Are there shared staffing agreements?
• Do you provide Wellness programs on-site or with
  a community partner?
• To what degree are peer specialists employed?
• Do you have Integration Strategic Plan?

21
Organizational Readiness

• Have you conducted an Integration Readiness
  Assessment for the agency or pilot program?
• What does your workforce look like? Physicians,
  SAMH Professionals, Nurses, Psychiatry, etc.
• Do you consider your agency as Co-occurring
  capable for SAMH? If so, how? Now, complexity
  capable?
• Is your agency involved in a network or merger
  that will draw on the strengths of all
  organizations?
• Do you know the mix of Indigent, Medicaid,
  Medicare, Dual Eligible or other local payer
  plans? (Counties)

22
COMPASS PH/BH (Cline, Minkoff)

• Self-assessment Tool
• Program Philosophy
• Administrative Policies
• Quality Improvement Data
• Access to Care
• Screening Identification
• Integrated Assessment

• Integrated Treatment Program Relationships
• Welcoming Policies
• Medication Management
• Integrated Discharge Transition Planning
• Program Collaboration Partnerships
• Staff Competencies

23
Pilot Tool Kit MTM Zia Partners

• Executive Walk through from a consumer
  perspective
• Admin. Readiness
• Self-assessment -Program Organizational Level
  PBHCI Capability
• Strategic Partnership Inventory

• Structured Prioritization Template
• Guidance on design Performance Plans with
  Indicators
• Project Planning and Organizational Templates
• References for Specific Materials (I.E. Tools)

24
Homeless Integrated Care Examples

• SAMHSA - PBHCI Grantee Seattle, WA. Downtown
  Emergency Services Center (DESC)
• Housing First Model Development Pathways to
  Housing PA Primary Care Partnership with
  Thomas Jefferson University Dept. of Family
  Community Medicine Philadelphia Dept. of
  Behavioral Health Office of Supportive Housing
• U.S. Dept. of Veterans Affairs Homeless
  Veterans Patient Aligned Care Teams (H-PACT)
  Homeless Medical Home 23 Pilots 37 sites
  funded in 2012/13

25
Contact Information

• mengelhardt_at_usf.edu
• 813-974-0769 (Direct Line)
• USF Florida Mental Health Institute (FMHI)
  Department of Mental Health, Law Policy
• http//mhlp.fmhi.usf.edu
• www.floridatac.org
• Thank You

26
Primary and Behavioral Health Care
Integration Practical Approaches to
ImplementationRick Hankey, Senior V. P. and
Hospital Administrator LifeStream Behavioral
Center, Inc.
27

• Mental health care cannot be divorced from
  primary care, and all attempts to do so are
  doomed to failure
• (Frank Degruy)

28
What is Integrated Care? Our Definition

• Integrated care is a service that combines
  medical and behavioral health services to more
  fully address the spectrum of problems that
  individuals have
• It meets patients where they are in their
  experience of problems or pain
• Integrated care is the structural realization of
  the biopsychosocial model
• Reunification in practice of mind and body

29
Collaborative Care-Where Were We?

• LESS
• Courtesy report of involvement
• Referral call for information exchange
• Development of special referral relationship
• Meeting to discuss cases
• Meeting of providers with patient
• Working together regularly in delivering services
• (Blount, 1998) MORE

30
Reasons for Integration Why We Did It

• The burden of behavioral disorders is great.
• Behavioral and physical health problems are
  interwoven.
• The treatment gap for behavioral disorders is
  enormous.
• Primary care settings for behavioral health
  services enhance access.
• Delivering behavioral health services in
  integrated care settings reduces stigma and
  discrimination.

31
Reasons for Integration Why We Did It

• Treating common behavioral disorders in
  integrated care settings is cost-effective.
• The majority of people with behavioral disorders
  treated in collaborative settings have good
  outcomes, particularly when linked to a network
  of services at a specialty care level and in the
  community.
• Individuals with serious mental illness die on
  average 25 years sooner than the general
  population.

32
Factors Increasing Health Risk
Poverty
Less Likely to be Screened
Poor Access to Primary Care
Self-Care Capacity/Resource
Disconnectedness of Physical Mental
Health Care Systems
Under Diagnosis Under Treatment
Cognitive, Affective and Behavioral Symptoms
Weight Gain
System Navigation Barriers
Tobacco and Substance Abuse
Medications
33
Reasons for Integration
Major Cause of Death Increased Risk of Death
CARDIOVASCULAR 3.4 X
LUNG CANCER 3 X
STROKE 2 X IN THOSE LESS THAN 50 YEARS OF AGE
RESPIRATORY 5 X
DIABETES 3.4 X
INFECTIOUS DISEASES 3.4 X
(Florida Council For Community Mental
Health)
34
Barriers to Integration

• Behavioral and physical health providers have
  long operated in their separate silos.
• Sharing of information rarely occurs.
• Confidentiality laws pertaining to substance
  abuse (federal and state) and mental health
  (state) are generally more restrictive than those
  pertaining to physical health. While HIPAA is
  often cited as a barrier to sharing information
  between primary care and mental health
  practitioners, this is not accurate sharing
  information for the purposes of care coordination
  is a permitted activity under HIPAA, not
  requiring formal consents.
• Payment and parity issues are prevalent.

35
Understand The Differences
36
Culture Differences
PRIMARY CARE BEHAVIORAL HEALTH
PACE 15 minute appointment 50 minute session
SETTING An exam room Office setting
LANGUAGE Diagnosis, medical terminology, complaints Assessment, behavioral health terminology, issues
HIERARCHY Clear Doctor in charge Diffuse Administrator in Charge with Medical Director
FLOW Flexible patient flow Scheduled client flow
37
Integration Considerations
38
Readiness Assessment

• Leadership and Relationship Building
• High Performing Provider-Access and Outcomes
• Person Centered Healthcare Home Participation
• Business Infrastructure
• Consumer Advocacy

39
Readiness Assessment-Leadership

• How active are you pursuing relationship building
  with leaders in the healthcare community?
• How successful have you been in communicating the
  importance of mental health and substance use
  treatment in improving quality in the healthcare
  system?
• Are you involved in assessing community needs and
  designing a local health improvement plan?
• How involved are you in planning and decision
  making at the state level? Do you local leaders
  understand and support integration?
• What have you done to develop and implement
  healthcare reform education within your
  organization? At what level has the discussion
  been held and what depth? Do you know how
  integration will affect your organization and
  community? What is the organization commitment?
• How educated is your community?

40
Readiness Assessment-High Performing Provider

• Readiness and recovery deeply embedded into your
  culture?
• How quickly can individuals get access to care?
  Two hours for emergent? 24 hours for urgent and
  no later than 7 days for routine care requests?
• How much is evidence based practices and programs
  utilized in your organization? Does leadership
  prioritize and promote the use of EBP?
• Does your organization use person centered care
  planning and consumer engagement?
• Are care management models utilized in your
  agency? Does your agency know the difference
  between case and care management?
• Are you familiar with treat to target approach?
• Are you a high performing provider?

41
Readiness Assessment Person Centered Healthcare
Home

• Have you worked closely with your communitys
  primary care partners to determine how involved
  to ensure that all consumers with mental
  health/substance abuse disorders have a
  person-centered healthcare home?
• How capable are you of being a good neighbor to
  the Person Centered Health Home, including
• a) effective communication, coordination and
  integration with health homes
• b) appropriate and timely consultations and
  referrals
• c)efficient, appropriate and effective flow
  of patient/care information
• d)providing guidance in determining
  responsibility in co-management situations and
• e) supporting the health home as the leader
  of the care team

42
Readiness Assessment Infrastructure

• Where is your organization regarding information
  technology? Do you have a electronic record that
  is available and appropriate for all staff? Is
  your information technology able to support
  real-time clinical decision making, quality
  improvement and effective management?
• Is quality improvement part of your
  organizational culture or just as a department?
  How quickly can you complete Rapid Cycle
  Improvement?
• How effective is your revenue cycle management?
• Are you familiar with new payment models? If
  not, are you willing to learn them?
• How bullet proof is your compliance plan and does
  it address healthcare reform, fraud and abuse?

43
Readiness Assessment Consumer Advocacy

• Do you have a workforce expansion plan?
• How well educated are you on federal parity
  implementation? Do you have linkages with
  federal and state organizations to support or
  educate your agency on the implementation of
  federal parity regulations for Medicaid, Health
  Exchanges and private health insurance?
• Do you have an enrollment strategy that provides
  outreach, assistance with the enrollment process
  and advocacy for the removal of structural
  barriers?
• Are you ready to meet the needs of the additional
  population?

44
The Wellness Integration Network (W.I.N.) Clinic
45
W.I.N. Clinic Philosophy
CONSUMER CENTERED APPROACH HEALTH HOME
46
The W.I.N. Clinic Model

• Components
• Integrated services
• Screen/registry tracking and outcomes
• Primary care staff located in behavioral health
  setting/no FQHC
• Embedded Nurse Care Managers
• Wellness/prevention programming

• Evidence Based Models
• SBIRT
• IMPACT (Improving Mood-Promoting Access to
  Collaborative Treatment) Model
• Motivational Enhancement Techniques (MET)
• Eli Lilly Wellness Program

47
W.I.N. Clinic-Our Program

• Integration Model Co-locate primary care
  physicians in behavioral health facilities to
  provide routine primary care services and serve
  as a consultant to the psychiatric care team all
  staff are employed by LifeStream. There is no
  FQHC involvement.
• Service delivery includes providing wellness
  programming and incorporating integrated
  services psychiatric and primary care are
  offered during the same visit. The clinic
  serves as a Medical Home. Specialty care is
  provided through agreements with community
  partners.
• Enrollment Target 1,000 during the four year
  grant period.
• Populations Served Adults with serious mental
  illness living in Lake County who do not have
  access to primary care services or a medical
  home.

48
W.I.N. Clinic-Our Program

• SERVICES PROVIDED
• Integrated Primary and Behavioral Health Care
  both services provided during the same
  appointment (when applicable), along with
  appropriate follow up. Emphasis is on preventive
  care.
• Home visits by LPN Care Managers to coordinate
  and monitor care and assess goals.
• Referrals to specialists and enhanced care
  coordination. The clinic has had great success
  with coordinating free and/or reduced rates with
  the specialists in our community for our clients.
• Transportation to appointments when needed.

49
W.I.N. Clinic-Our Program

• Wellness Activities and workshops on topics such
  as exercise, diet and nutrition, weight
  management, and tobacco cessation.
• Wellness activities include wellness testing
  (fitness and medical tests), health risk
  appraisals, hypertension screening and education,
  disease management seminars, in home education
  with care managers, stress management activities,
  and time management workshops
• Access to LifeStreams full continuum of care,
  including behavioral health and substance abuse
  services.

50
W.I.N. Clinic Work Flow
51
W.I.N. Clinic-Staff

• Medical Provider
• Performs examinations, wound care, assigns care
  managers, prescribes medications, and completes
  histories, physicals and psychiatric evaluations.
  
• Lead LPN Care Manager
• Assists the medical provider, monitors all care
  managers, prepares education packets for clients,
  recruits new clients and is responsible for
  marketing.
• Care Managers
• Responsible for home visits, charting, monitoring
  progress, wellness activities, treatment plans,
  education and teaching of consumers.
• Follow-up Specialist
• Responsible for contacting clients at 6, 12, and
  18 months monitoring progress towards treatment
  plan goals assisting clients with affordable
  prescriptions and referrals for patient
  assistance and transporting.
• Administrative Support
• Responsible for completing the NOMS, scheduling
  appointments, contacting referrals, and data
  entry.

52
The W.I.N. Clinic-Successful Strategies

• Care Managers educate clients on nutrition and
  the importance of eating the right foods.
• A personalized diet plan with weekly menus is
  provided.
• Weekly trips to the grocery store teach clients
  how to shop for nutritious foods.
• Cooking lessons are provided on how to prepare
  healthy meals and show clients that healthy food
  does not have to be unappetizing or expensive.
• As a result, average weight loss is 15 pounds.
  Over 48 of the consumers report weight loss.
• Care Managers utilize MET with consumers with
  regard to exercise regimen, often starting out
  with basic exercise such as walking. Care
  Managers often participate in activities to
  encourage consumer participation.

53
What Does our Data Suggest?
Outcome WIN Data All Grants
Functioning in every day life 79 32
No serious psychological distress 44 18
Retained in the community 41 9
Stable Housing 25 12
Education/employment 27 12
Overall Healthy 56 22
Illegal substance use 15 7.3
Social Connected 19 18
54
Lessons Learned

• Hurdles, challenges and obstacles, oh my!!
• -Personnel issues
• -Cultural change/paradigm shift
• -Lab work, medications, specialty care
• -Workforce development
• What may seem simple often is not.
• -Referrals
• -EHR Considerations
• -Wellness Activities

55
Lessons Learned (continued)

• It takes a village to raise a child
• -Partnerships are important
• -Teamwork Are you ready???
• Just when things are working smoothly
• -Systems Issues/Client flow
• -Program fidelity
• -Funding Issues/Sustainability

56
Recommendations for Implementing Integrated Care

• Think big, start small
• Improve physical proximity
• Keep a joint medical record
• Focus on primary care providers as important
  customers for mental health providers
• Explore new practice styles
• Senior management buy-in is critical
• Learn and understand billing codes and funding
  sources

57
Recommendations for Implementing Integrated Care

• Include mental health consultation earlier in the
  course of a patients evaluation in order to
  minimize unnecessary expenses
• View patients as people the organization is
  committed to working with over time, rather than
  people presenting a series of isolated treatment
  episodes
• Its not all about your organization but the
  people we serve
• Teamwork, partnerships and thinking outside of
  the box are very critical for success.

58
Contact Information

• Rick Hankey, Senior Vice President and Hospital
  Administrator
• LifeStream Behavioral Center,
• Leesburg, Florida
• Email rhankey_at_lsbc.net
• Telephone [phone]

59
Integrated care on a small scale

• Laureen Pagel
• CEO
• Starting Point Behavioral Healthcare

60
Integrated care - Important Facts

• Bi-directional integration is critical for
  improving patient care and containing costs
• Changes due to HCR will have a great impact on
  the way SAMH services are delivered and financed
• Health homes is seen as a move toward integration

61
Integrated Care - How do I begin?

• Identify community partners
• FQHC
• Rural health clinics
• Primary care practices
• Hospital
• Managed care plans

62
Integration Core Competencies

• Interpersonal communication
• Collaboration teamwork
• Screening assessment
• Care planning coordination
• Intervention
• Cultural competence adaptation
• Systems oriented practice
• Practice-based learning Quality improvement
• Informatics

63
Integrated care - Whats in it for me?

• The most successful integration attempts are
  those in which the needs of the medical care
  setting are considered primary.
• Ask yourself How can integration be seen as
  solving an existing problem in primary care?
• Educate primary care about the efficacy and cost
  effectiveness of integrated care.
• Model must be a good fit for that setting.

64
Integrated care How did SPBH do it?

• Partnered with another agency to write an FQHC
  planning grant
• Met for a year with community stakeholders to
  gather health data and identify unmet needs
• Reached out to RHC on west side of county about
  co-location of services
• It took a year of relationship building to make
  any progress.
• These are examples of core competencies I II.

65
Integrated care - Our integration model

• Worked with nursing staff at RHC to get buy-in.
• Surveyed their clients to determine need and
  motivation for SAMH services.
• Placed an LCSW on site 1 day a week. Conduct
  screenings using the PHQ, crisis intervention,
  and individual sessions from 30-60 minutes. (core
  competencies III and V)
• We bill the clients for her time. Most clients
  have Medicaid.
• All services are documented in our electronic
  health record. (core competency IX)
• Use Outreach for her screening time.

66
Integrated care - Another opportunity

• Our community partner wrote us in on a Blue
  Foundation grant for MH services at their medical
  clinic.
• We wrote them into a WGA grant for MH services
  for women and girls with trauma.
• Both grants were awarded. Evidenced-based
  practices are utilized for both grants.
• We have 10 hours of MH services at their clinic
  paid by Blue Foundation and 24 hours paid by WGA
• A therapist is on site 5 days a week
• We can bill Medicaid for all eligible services

67
Integrated care - Next Steps

• Meet with staff at medical clinic weekly to
  review process and make adjustments as needed
  (core competency VII)
• Working with our local hospital on strategic
  partnerships.
• In talks with our Hospital President about having
  a social worker and case manager team to screen
  patients in the ER.

68
Thank You!

• Laureen Pagel, PhD, MS, CAP, CPP, CMHP
• Starting Point Behavioral Healthcare, CEO
• lpagel_at_spbh.org
• 904-225-8280 ext. 416
• www.spbh.org

69
Community Healthcare Integration A Coalitions
Role

• Rita Chamberlain, MBA
• Associate Director, Manatee County (FL) Substance
  Abuse Coalition

70
Rationale

• The Affordable Care Act is an opportunity to make
  prevention services a national priority
• There are numerous opportunities to expand and
  integrate prevention with the services of other
  healthcare providers
• People want more than treatment for illnesses,
  they want to be kept healthy
• Prevention has a major role to play in promoting
  and preserving wellness
• ACA requires insurance companies to cover
  preventive care
• Coalitions are the voice for prevention in
  communities
• Source The Power of Prevention, Healthcare
  Reform The role for substance abuse prevention,
  by Terese Voge and Kerrilyn Scott-Nakai,
  Community Prevention Initiative, 2011.

71
ACAS DEFINITION OF PREVENTION

• Reduction of obesity through physical activity
  and improved nutrition
• Addressing smoking and other tobacco use with
  prevention and cessation programs
• Prevention of HIV
• Increasing mental health and substance abuse
  prevention services that promote wellness and
  reduce risk for serious emotional problems

Source The Power of Prevention, Healthcare
Reform The role for substance abuse prevention,
by Terese Voge and Kerrilyn Scott-Nakai,
Community Prevention Initiative, 2011.
72

• From CADCAs Coalitions and Community Health
  Integration of Behavioral Health and Primary Care
• Together, coalitions and community stakeholders
  can address integration comprehensively and
  ensure that the community experiences measurable
  and meaningful improvements in population-level
  outcomes as a result.

73
Keep in mindthe social geographyof the issue !
74
How To Work Together Coalition Thinking

• Vertical integration
• The role of the convener
• Adaptive vs. Technical problem
• Solutions for complex problems Theory U

75
Coalition as CatalystAdaptive Approach

• Loose connections
• Mapping (linking)
• Passion
• Emotional intelligence
• Trust in process
• Inspiration
• Tolerance of ambiguity
• Hands off approach
• Receding
• Backing away as work advances
• And--pointing at the pole star

76
To a realistic shared solution
A new group wants to jump to solutions
But a wise convener leads them through the U
C. Otto Scharmer (2007) Theory U Thanks to Gary
Oftedahl for the Theory U diagram
77
Five Specific Roles Coalitions Can Play

• Promote Collaboration
• Educate About Integration
• Engage in Outreach and Enrollment Activities
• Support Integrated Care Service Development and
  Delivery
• Support Integrated Care Workforce Development

78
SunCoast Regional Plan for Coalitions

• Promote Collaboration
• Coalition and Provider Survey
• SAFE Rx Initiative
• Engage Treatment Providers
• Educate about Integration
• Regional Presentation on ACA and Integration
• Engage Treatment Providers
• Engage in Outreach and enrollment opportunities
• Tie into surveys being conducted in our community
• Have info pages at office or in displays and
  community health fairs
• Support Integrated Care Services Development and
  Delivery
• Speakers bureau based on survey for providers to
  help lay the ground work
• Support Integrated Care Workforce Development
• Provider Survey and Speakers Bureau in regards to
  education and training
• Developed by Chrissie Parris, Coalition
  Coordinator, Alliance for Substance Abuse
  Prevention - ASAP of Pasco County
• Lisa Jones,
  Central Florida Behavioral Health Network, Inc.
  Prevention Program Manager

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Need More Information?

• Resource Links
• CADCA
• http//www.cadca.org/
• Coalitions and Community Health
• http//www.integration.samhsa.gov/
• Power of Prevention
• http//www.cars-rp.org/publications/PowerOfPrevent
  ion/POP_0102.pdf

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Thank You!
Rita Chamberlain, MBA Manatee County Substance
Abuse Coalition (MCSAC) Associate
Director/CFO Email rchamberlain_at_drugfreemanatee.o
rg Phone [phone] X 3477 www.drugfreemanatee
.org
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Behavioral Health Integration to Primary Care

• Kay Doughty, MA, CAP, CPP
• VP, Family and Community Services
• Operation PAR, Inc.

Phillip J. "P.J." Brooks, LMHC Vice President,
Outpatient and Youth Services First Step of
Sarasota, Inc.
82
Whats in it for me?

• Why integrate?
• Parity
• Affordable Care Act
• Our world is changing
• Making change
• Understanding what you can control
• Funding
• Consider repurposing funds.

83
Our History

• Small Steps
• SAMSHA grant working with FQHCs
• Circumstances
• Collaboration

84
Rate of Fetal Substance Exposure
Source Hal Johnson, MPH, Florida Department of
Children and Families.
85
THE PROBLEM

• What can be done in Pinellas County to intervene
  with mothers who have delivered (or will deliver)
  an NAS infant?

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CONCEPT

• A program designed to engage pregnant or post
  partum prescription using mother into services
  with a Behavioral Health Consultant with the
  ultimate goal of engaging the mother in substance
  abuse services and the completion of in-home
  parenting classes

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WHAT WAS DONE?

• Introduce concept to Substance Exposed Newborn
  workgroup--Collaboration
• Met independently with staff from Neonatal
  Intensive Care Units (NICUs) to introduce
  concept with how tos (our expectations of
  Behavioral Health Consultants) and
• 1. Elicit their willingness
• 2. Brainstorm actual practice and identify
• barriers, needed actions, and next
  steps. Care
• Coordination

88
WHAT WAS DONE?

• 3. Determine key individuals whose approval
• needed. Collaboration
• Internal planning to complete follow-up
  connections, forms, etc.
• Next meeting with hospital staff to review
  actions to date same process Collaboration
• Set start date and pilot

89
WHAT WAS DONE?

• Continual meetings with key players to assess
  implementation and remove barriers identified.
  Collaboration/Care Coordination/System
  Orientation/Cultural Competence/ Practice Based
  Learning
• Quarterly meetings with hospitals
• Expand reach to High Risk Pregnancy center and
  Methadone Treatment Programs.
• Report out to SEN committee

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Motivating New Moms

• Consultants receive referrals from Hospitals,
  High Risk Pregnancy Centers, Child Welfare, and
  Substance Abuse Treatment Facilities.
  Screening/Assessment
• Consultants begin engaging mother with in
  home/hospital visits using the Nurturing
  Parenting Curriculum and providing referrals to
  community based programs to help support the
  mother Intervention

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Collaborative Expansions

• LAUNCH grant opportunity
• Implementation of Parenting Prevention Services
  integrated into Community Health Center services
  (Planned Expansion)
• Implementation of S-BIRT services at Community
  Health Center (in process)

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Help Primary Care with their Problem

• Help them see what they dont know about their
  problem patients
• Primary care is just as concerned and confused
  about the impact of the Affordable Care Act
• Find an in through a secondary partner i.e.
  Healthy Start, Child Welfare, etc.
• Offer Staff training on Motivational
  Interviewing, SBIRT, etc.
• Synchronize our target populations
• Learn how to approach primary care practices from
  Pharmaceutical/Medical supply industry
• Sell your Managing Entity on Integrated
  Intervention

93
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Contact Information
Phillip J. "P.J." Brooks, LMHC Vice President,
Outpatient and Youth Services First Step of
Sarasota, Inc. 941-552-2078 ext.
1303 PBrooks_at_fsos.org

• Kay M. Doughty, MA, CAP, CPP
• VP, Family and Community Services
• Operation PAR, Inc.
• [phone]  ext. 274
• kdoughty_at_operpar.org

95
Resource

• The SAMHSA-HRSA Center for Integrated Health
  Solutions (CIHS) promotes the development of
  integrated primary and behavioral health services
  to better address the needs of individuals with
  mental health and substance use conditions,
  whether seen in specialty behavioral health or
  primary care provider settings.
• The Center provides training and technical
  assistance to 100 community behavioral health
  organizations as well as to community health
  centers and other primary care and behavioral
  health organizations.
• http//www.integration.samhsa.gov/about-us

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• Social Workers
• Addiction Treatment Professionals
• Psychiatrists
• Peer Specialists
• Case Managers
• Behavioral Health Consultants
• Frontline staff
• P.S. Primary Care Clinicians

97
Questions/Group Activity/Discussion