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Integrated Learning Collaborative

Integrated Learning Collaborative. Treatment of Substance Use and Mental Health Disorders in Primary Care in the Era of Health Reform February 22, 2012. Integration of Mental Health & Substance Use Disorders into Primary Care: Models of Co-Located and Integrated Services. Lily Alvarez

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Integrated Learning Collaborative

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  1. Integrated Learning Collaborative Treatment of Substance Use and Mental Health Disorders in Primary Care in the Era of Health Reform February 22, 2012

  2. Integration of Mental Health & Substance Use Disorders into Primary Care: Models of Co-Located and Integrated Services Lily Alvarez Kern County Mental Health Darren Urada, PHD UCLA Integrated Substance Abuse Programs

  3. What Does Our County Look Like? • Mental Health System of Care • Substance Abuse System of Care • FQHCs

  4. What MHSA Opportunities are Provided? • Integration • Workforce • Two services in same day • Address both MH and SUD • Time

  5. Spoken Goals • Universal screening • Brief interventions • Technology via health registries

  6. Unspoken Goals • Develop a value for the SAS • Develop the blood pressure cuff for SUD • Close the gap between primary care and specialty care • Demonstrate how to overcome security and privacy issues • Building capacity for 2014

  7. What is the Model? • Universal screening • Brief consultation in the exam room • Brief interventions • Integrated case conferencing • Using data to monitor progress

  8. Anticipated Barriers and Proposed Solutions • Being in the forefront; creating a learning environment • Competition; monthly provider meetings • Physician involvement; contractual requirements for case conferencing • New practice standards; technology transfer through events

  9. Current Barriers • Fear of recognizing the SUD patient • Filing in the medical record • Charting in the medical record

  10. Health Information Exchange • 42 CFR Part 2 requires: Individual consent Specificity Prohibits re-disclosure • Between primary care and specialty Diagnosis Lab results Medications

  11. UCLA and Evaluation • Prevalence • Baseline with the Dual Diagnosis Capability in Health Care Settings (DDCHCS) tool • The pipeline using i2i data • Perceptions and attitudes

  12. Prevalence Preliminary Results • Prevalence of depression • Prevalence of thought disorders • Prevalence of alcohol and drug

  13. DDCHCS Integration Measure: Baseline • Completed in 2011 • Follow-up planned in 2012 • A word about the scores… • “5” is not necessarily the goal • Although this is a measure of integration, for some sites it may be impossible or even undesirable to reach “5” on DDCHCS. • Not every hospital needs to be a Level-I trauma center. Not every site needs a 5 on DDCHCS. • This is a snapshot to allow sites to assess where they are, whatever the goal is.

  14. Administrative Data“Patient Pipeline” Referred for assess- ment All Patients Positive Screen Screened Positive Assessment Assessed Referred: on-site intervention Referred: off-site treatment NoShows Rec’d Inter- vention Rec’d Treat- ment

  15. Staff Perceptions & Attitudes Surveys Adapted from surveys developed by the Integrated Behavioral Health Project (http://www.ibhp.org/) Multiple versions used: • Behavioral Healthcare Provider Satisfaction Survey • Primary Care Provider Satisfaction Survey • Primary Care Provider Satisfaction Survey - Non PCP Staff

  16. Examples of survey questions (out of 23)

  17. * = Statistically significant difference in ratings between staff types

  18. Questions / Comments?

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