Behavioral & Somatic Health Integration

1. Behavioral & Somatic Health Integration Presented by: Kathleen Reynolds, LMSW ACSW October 18, 2011

2. Making the Case for Integration • Persons with serious and persistent mental illness are dying 25 years younger (NASMHPD, 2006) • Nearly 50% of claims documents in low income primary care clinics are for behavioral health issues (Mautsch, 1995) • Integrating care results in cost efficiencies for the system • Integrated health care produces better health outcomes

3. Substance Use Disorders and Primary Care • Substance use increases the risk for hypertension (x2), congestive heart failure (x9), and pneumonia (x12) • Patients in chemical dependency programs are 18 times more likely to have major psychosis, 15 times more likely to have depression, and nine times more likely to have an anxiety disorder • Patients with HIV and a substance use disorder are more likely to be non‐adherent to HIV care; • Medicaid recipients with a substance use disorder are more likely to be readmitted to a hospital within 30 days;

4. Medicaid Utilization – Substance Use Disorders

7. What is integration? • Bi-Directional • Primary care services provided in behavioral health settings • Behavioral health services provided in primary care settings • Levels of Collaboration

11. Models of Integration Behavioral Health –Disease Specific • IMPACT • RWJ • MacArthur Foundation • Diamond Project • Hogg Foundation for Mental Health • Primary Behavioral Healthcare Integration Grantees Behavioral Health - Systemic Approaches • Cherokee Health System • Washtenaw Community Health Organization • American Association of Pediatrics - Toolkit • Collaborative Health Care Association • Health Navigator Training • Physical Health • TEAMcare • Diabetes (American Diabetes Assoc) • Heart Disease • Integrated Behavioral Health Project – California – FQHCs Integration • Maine Health Access Foundation – FQHC/CMHC Partnerships • Virginia Healthcare Foundation – Pharmacy Management • PCARE – Care Management • Consumer Involvement • HARP – Stanford • Health and Wellness Screening – New Jersey (Peggy Swarbrick) • Peer Support (Larry Fricks)

12. Opportunities for Integration – Substance Use Services • SBIRT Services • Medication Assisted Treatment

13. SBIRT • Screening • What evidence based tool should be used? • Brief Intervention • Motivational Interviewing training • Physician based interventions • Referral • Establish solid referral relationships with primary care • Self help options • Treatment • Specialty treatment options

14. Medication in Treatment of Substance Use Disorders • Expanding into primary care and into SA/MH organizations • Support for prescribers in primary care • Assistance with protocols and management techniques

15. The Roles for Consumers • Mental Health Peer Supports • Recovery Coaches • Community Health Workers

16. Peer Recovery Coaches • Excerpted from Faces and Voices of Recovery/Definition of Peer Recovery Coach • Personal guide and mentor for individuals/families seeking to • initiate, achieve and sustain long-term recovery from addiction • including medication assisted, faith based, 12 step and other • pathways to recovery • Connector and navigator in recovery supportive • systems and resources including housing, employment, and • other professional and non-professional services • Liaison to formal and informal community supports, • resources and recovery supporting activities

17. The CIHS • Awarded to the National Council for Community Behavioral HealthCare • Four years; $5.3 Million/year • Target Audience • SAMHSA Grantees • HRSA Grantees • General Public • Services • Training and Technical Assistance • Knowledge Development • Prevention and Wellness • Workforce Development • Health Reform Monitoring and Updates