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