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2007 MeHAF Integration Initiative: Quantitative Results & Evaluation Framework

This presentation provides an overview of the quantitative findings for the 2007 grantees of the MeHAF Integration Initiative. It covers the assessment and referral of people for integrated services, clinical outcomes, and the evaluation framework used. Data on project reach results, effectiveness measurements, and selected findings for grantees are discussed, offering insights into the impact and challenges faced by the initiatives. Engage in a meaningful discussion on the interpretation and implications of the data presented to gain a deeper understanding of the program's outcomes.

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2007 MeHAF Integration Initiative: Quantitative Results & Evaluation Framework

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  1. MeHAF Integration InitiativeQuantitative Results – 2007 Implementation Grantees Eugenie Coakley, Susan Grantham, Alec McKinney, Natalie Truesdell, Melina Ward May 4, 2012

  2. Overview & Format of Presentation • Describe quantitative findings for 2007 grantees • # People assessed & referred for integrated services • Clinical outcomes • Group discussion of the data • Interpretation – what might the data mean? • Assessment – what are the strengths/limitations of the data? • Format – Present and discuss (5 minutes, small groups)

  3. JSI’s Evaluation Framework: RE-AIM

  4. Description of the 2007 Grantees • 14 Implementation projects funded by MeHAF starting in 2007, for three years (2007-2009) • Two ways (linkage mechanisms) were used to link Behavioral/Mental Health Providers and Primary Care Providers: • Referral/consultation (4 projects) • Co-location (10 projects) • Projects were implemented in a variety of sites (settings) – PC practices & CHCs; also B/MH offices, schools, emergency room, dental office

  5. Measures of Project “Reach” • The number of people who came in contact with integrated services (“reached”) as a result of these projects • Assessed by a B/MH provider after screening for symptoms • Referred for further services based on assessment and patient/provider discussion • Most referrals were to the assessing B/MH provider • Treated in the form of further face-to-face visits with B/MH provider Data Source: JSI’s Client Data Elements (CDE) Access data base

  6. Project Reach Results • 7,364 people were assessed for integrated services • 1,014 in 2 consultation projects • 6,350 in 9 co-located projects • 3,651 (57%) were referred for additional integrated services • The other 43% - no need for further services at that time rarely was it noted in the CDE that patients refused a referral • Of those referred, most were treated over the course of 90 days after the referral: • 41% (1,497) had multiple B/MH visits • 18% ( 657) had one B/MH visit • 41% (1,497) had no B/MH visits

  7. People Assessed for Integrated Behavioral Health (IBH) Services by Quarter IBH = integrated behavioral health

  8. Percent of People Treated within 90 days, by Grantee

  9. Time to Consider & Discuss • What are some ways you are interpreting these statistics? Questions raised? • What might cause the assessment trend line to increase and then decrease over time? • Is 59% of the patients having follow-up appointments “reasonable”? What ways might be used to verify/compare such findings?

  10. Measures of Project “Effectiveness” • Focus on one dimension of effectiveness – client clinical outcomes • Measures selected by grantee, collected by sites • Depression, anxiety, psychosocial health/functioning, physical health status, more reach statistics • JSI instructed data to be collected on those initially assessed and referred for additional IBHservices

  11. Effectiveness Measurement Issues • Identifying the right people • data system and staffing constraints • Picking the measurement that fits the conditions treated and understanding how to interpret it • Initial severity determines the size of change score and the amount of time it takes to achieve a substantive change • Collecting multiple measurements • patient participation in repeated measurement • timing of follow-up measurement(s) • impact on work flow • measurement for treatment vs. screening

  12. Varied ability to collect clinical outcome data

  13. Selected Findings for 2007 Grantees with Limited Outcome Data

  14. Grantee 1: Worked with 41 young adults with psycho-social issues Data available for all youth served, using the Global Assessment of Functioning Scale

  15. Grantee 2: Provided Co-located IBH in 3 Remote PC Adult Practices • Only 1 of 3 practices supplied data for half of the reporting period, representing 15/118 (13%) of assessed patients. 6/15 also had a follow-up measure. Measure: interpersonal/social role functioning

  16. Grantee 3: Providing co-located IBH for Adults & Children • Grantee 3: Data on PHQ-9 and GAD-7 for 313 adults indicates a lot of co-morbid depression and anxiety.

  17. Time to Consider & Discuss • What are some ways you are interpreting these results? Any questions? • Do you think these data are valuable? In what ways? • What advice do have to help strengthen the data?

  18. Selected Findings for 2007 Grantees with More Complete Outcome Data

  19. Grantee 8:CHC Co-located IBH for People with Depression • PHQ-9 is part of routine care; completed at the start of every PC visit and prior to BH visits for those with depression. • The follow-up dated closest to 90 days after the MeHAF initial assessment was chosen for this evaluation; typically 50-60 days later. • All 3 clinics reported data • 80% of 167 patients had an initial and follow-up assessment

  20. Grantee 8: Statistically Significantly Reduced Depression Symptoms Severe Moderate- to-Severe Moderate Mild None

  21. Grantee 8: Clinically Significantly Reduced Depression Symptoms • 50% reduction in symptoms OR PHQ-score <= 5 points attained by: • Site 1: 67% (22/33) people • Site 2: 34% (12/35) people • Site 3: 47% (30/64) people • Overall: 48% (64/132) people

  22. Grantee 8: Sample table

  23. Grantee 10: Peer Support Center Providing Primary Care Peer Navigation & Improved Food Service • Outcome measure: change in weight • 30 members agreed to be weighed monthly • Over the course of 6 months, 22 were measured 2-3 times • 4 members’ goal – weight gain • 18 members’ goal – weight loss

  24. Grantee 10: Peer Support Center Providing Primary Care Peer Navigation & Improved Food Service • The group needing to gain weight gained an average of 8.25 pounds • 2 gained > 5 lbs. over 4-6 months • 2 gained 1-5 lbs. over 1-2 months • The group needing to lose weight lost anaverage of 9.0 pounds • 9 lost > 5 lbs. • 1 gained > 5 lbs. • 8 maintained weight +/- 5 lbs.

  25. Time to Consider & Discuss • How are you interpreting these statistics? What are the strengths and limitations? • Could you envision being able to collect this type of data at your site? Would it be useful? • Could this kind of data be helpful for securing additional funding?

  26. Summary of Quantitative Results for 2007 Implementation Grantees • Access to integrated behavioral/mental health services was provided to over 7,000 Maine residents • Nearly 60% were referred for additional services, and of these people, about 60% engaged those services • Measuring clinical outcomes was very challenging • Able to show with initial assessment data that they were reaching high needs groups • Mostly descriptive data; only in a few cases could the potential impact of services be estimated

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