Integrated Behavioral Health & Primary Care National/State

Report
Florida Partners in Crisis 2012 Conference
Mark A. Engelhardt, MS, MSW, ACSW
USF – FMHI – Dept. of Mental Health
Law & Policy
July 12, 2012, Orlando
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The Case for Integrated Care
 People with mental health and substance abuse disorders
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die 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
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Organizational Support (2003-12)
 World Health Organization
 Substance Abuse and Mental Health Service
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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 (FQHC’s)
Health & Behavioral Healthcare Advocates
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SAMHSA – HRSA Solutions
 Target = People with Serious Mental Illnesses
 64 Current SAMHSA-HRSA Primary Behavioral
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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 (HER) with grantees
30 PBHCI Grant applications to be awarded in 2012
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Grantee Evaluation: Rand Corp.
 56 Grantees included in the National Evaluation
 67% Partnered with FQHC’s
 Over 12,000 served since 10/1/09
 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
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Southeast Learning Community
 Six (6) Florida Grantees
 Miami Behavioral Health
 Apalachee Center –
Tallahassee
 Coastal Behavioral
Healthcare – Sarasota
 Lakeside Behavioral
Healthcare – Orlando
 Lifestream Behavioral
Healthcare - Leesburg
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Center – Miami
Community
Rehabilitation Center –
Jacksonville
Others in Region 3 =
Cobb/Douglas – Georgia
Tri-County CMH/State
of South Carolina
Norfolk, Va. (CSB)
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Four Quadrant Model
 Population Based (NCCBH)
Population with low to moderate risk/complexity for
both behavioral and physical health issues
2. High Behavioral health risk/complexity and low to
moderate physical health risk/complexity
3. Low to moderate behavioral health risk/complexity
and high physical health risk/complexity
4. High risk and complexity I for both behavioral and
physical health ( SAMHSA – HRSA Grant focus)
1.
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Integration Models (A Few)
 Primary Care in Behavioral Health Settings; Behavioral
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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
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Workforce Issues
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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
 Cultural proficiency
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Clinical Considerations
 Screening Tools ( I.E. SBIRT – Screening, Brief
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Intervention & Referral to Treatment)
Health Indicators ( Substance use, tobacco, blood
pressure, cholesterol, weight, nutrition, etc.)
Motivational Interviewing
Medication Assisted Treatment – Pharmacology
Pain Management
Trauma
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PBHCI Programs
 Million Heart Campaign – National HHS campaign to
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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
Substance abuse prevention/relapse
Targeted populations = homeless, drop-in centers,
“housing is healthcare”, in-vivo.
Interns , students, volunteers, existing programs
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Administration & Operations
 Memorandum of Understanding with partners (I.E.
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FQHC’s) – Array of services ; who will provide what?
Contracts and formal agreements
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
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COMPASS PH/BH (Cline, Minkoff)
 Self-assessment Tool
 Integrated Treatment
 Program Philosophy
 Administrative Policies
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 Quality Improvement &
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Data
 Access to Care
 Screening &
Identification
 Integrated Assessment
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Program & Relationships
Welcoming Policies
Medication Management
Integrated Discharge &
Transition Planning
Program Collaboration &
Partnerships
Staff Competencies
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Contact Information
 [email protected]
 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
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