Integrated Behavioral Health & Primary Care National/State Development

1. Integrated Behavioral Health & Primary CareNational/State Development Florida Partners in Crisis 2012 Conference Mark A. Engelhardt, MS, MSW, ACSW USF – FMHI – Dept. of Mental Health Law & Policy July 12, 2012, Orlando

2. The Case for Integrated Care • People with mental health and substance abuse disorders 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

3. Organizational Support (2003-12) • 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 (FQHC’s) • Health & Behavioral Healthcare Advocates

4. SAMHSA – HRSA Solutions • Target = People with Serious Mental Illnesses • 64 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 (HER) with grantees • 30 PBHCI Grant applications to be awarded in 2012

5. 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

6. Southeast Learning Community • Six (6) Florida Grantees • Apalachee Center – Tallahassee • Coastal Behavioral Healthcare – Sarasota • Lakeside Behavioral Healthcare – Orlando • Lifestream Behavioral Healthcare - Leesburg • Miami Behavioral Health Center – Miami • Community Rehabilitation Center – Jacksonville • Others in Region 3 = Cobb/Douglas – Georgia • Tri-County CMH/State of South Carolina • Norfolk, Va. (CSB)

7. 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 I for both behavioral and physical health ( SAMHSA – HRSA Grant focus)

8. 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

9. 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 • Cultural proficiency

10. 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 • Trauma

11. 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 • Substance abuse prevention/relapse • Targeted populations = homeless, drop-in centers, “housing is healthcare”, in-vivo. • Interns , students, volunteers, existing programs

12. Administration & Operations • Memorandum of Understanding with partners (I.E. 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

13. 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

14. Contact Information • mengelhardt@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