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INTEGRATION

INTEGRATION. IN AMADOR COUNTY BEHAVIORAL HEALTH DEPARTMENT. AMADOR COUNTY’S STORY. LESSONS LEARNED in IMPLEMENTING I NTEGRATION PROCESS Lessons Learned from HRSA’s early demonstration projects in primary care and behavioral health care integration:

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INTEGRATION

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  1. INTEGRATION IN AMADOR COUNTY BEHAVIORAL HEALTH DEPARTMENT

  2. AMADOR COUNTY’S STORY • LESSONS LEARNED in IMPLEMENTING INTEGRATION PROCESS • Lessons Learned from HRSA’s early demonstration projects in primary care and behavioral health care integration: • Organization needs to determine “Integration of what?” • No single path to achieve integration • Organizational environment and culture shape the model of integration • Funding alone does not insure integration occurs • Multi-year process • Program evaluation and CQI help guide and improve the process

  3. AMADOR COUNTY’S STORY HISTORY of ORGANIZATIONAL INTEGRATION FY 06-07 – ‘You can’t make me love you” • Board of Supervisors Resolution • WHY? – presented to BOS as an efficiency move • Combine ADS Dept and MHS Dept into organizational unit • Named combined department Behavioral Health • One director to replace 2 previous positions • Organizational development consultant hired for 1 year to effect more collegial relationship between the MHS & ADS staff

  4. AMADOR COUNTY’S STORY FY 07-08 – “Getting to know you” • New director hired from outside the County • Individual consults by new director with every staff member • Conjoint All Staff meetings • Joint membership workgroups • Move to new space • Increased opportunities for socialization

  5. AMADOR COUNTY’S STORY FY 08-09 – “One for All; All for One” • Fall of 08 discovered serious financial deficit in ADS programs • Hx of borrowing from each other’s funding and from the Public Health Trust • Layoffs required – offered new jobs • DUI and PC 1000 let to community contractor • Integrated CCS-MHSA funds in the FY 10 Budget throughout entire Dept • Need for more contemporary methods of treatment and care

  6. AMADOR COUNTY’S STORY FY 08-09 - “One for All; All for One” • Investigated various EBP models of care, • “Integrated Recovery Team Model” • “Integrate Dual Disorders Team”, • “Aggressive Case Management Model” , • “Comprehensive, Continuous, Integrated System Of Care Model” • Established “Integrated Recovery Teams” with features from each of the above models

  7. GOAL:Achieve comprehensive, coordinated, client centered, recovery oriented care for every BHD client

  8. AMADOR COUNTY’S STORY Integrated Recovery Team Characteristics • Membership of IRT • Core: Mental Health Clinician, Alcohol & Drug Counselor, and Personal Services Coordinator, Medical Records Clerk • Adjunct members: Patient Advocate, Family Advocate, Community-based partners • PRN: BHC Nurse, Psychiatrist

  9. AMADOR COUNTY’S STORY • Team = most important function in Dept • Each client has a team working for them—not an individual caseworker! • Each member of the team needs to be competent at a “minimum base” of knowledge and skills • Agenda driven team meetings twice/week for review and planning treatment plans and case work activities; • Clients and their family members encouraged to attend treatment planning

  10. AMADOR COUNTY’S STORY • Ongoing communication between team members re: role differentiation and expertise • Cross training improves functioning and continuity of care • Team decision making on every case re: medical necessity, tx plans, case management activities, etc. • Crisis stabilization, including discharge planning, is responsibility of the team whenever there is a crisis, hospitalization, or other residential admission

  11. AMADOR COUNTY’S STORY Characteristics of the Integrated Process • Access to service can be through department, referral resource, community-based partners, consumer wellness center • Universal Intake Process • Universal registration tool • Universal financial screening process • Clients receive the most appropriate service for their current need(s)

  12. Amador County’s Story Characteristics of the Integrated Process • Flow between mental health and alcohol & drug services is not apparent to the client • Funding clients’ services must be closely monitored; can be tied to service codes • Every care and treatment staff positions are partially funded with MHSA funds to insure capturing all funding streams for the services they provide uninsured.

  13. AMADOR COUNTY’S STORY Issues & Challenges of Organization and Services Integration • Fear of Change – • Dominance of one group over the other • Letting go of individual clients • Lack of confidence in the team process • Need for training and ongoing support • Expense and loss of revenue due to initial training needs • Administrative change in focus towards the facilitation of the teams

  14. AMADOR COUNTY’S STORY • Professional and consumers working side-by-side • Finding a IM system to accommodate recovery model and team caseloads • Buy-in from psychiatrist

  15. Amador County’s Story Presented by: George Sonsel, L.C.S.W. Director, Behavioral Health Department 10877 Conductor Blvd, Suite 300 Sutter Creek, CA 95685 (209) 223-6296 gsonsel@amadorgov.org

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