Cooperative Health Center Inc. Helena, Montana

1. Cooperative Health Center Inc.Helena, Montana Patrick Frawley, LCSW

2. Our Community • Lewis & Clark County covers 3,500 square miles • 2009 estimated population of 62,000 • Average per capita income $19,000 • 29% below 200% poverty level, and 44% of those are uninsured

3. Our Clinic • Opened in 1994 • Satellite clinics – Lincoln, MT and God’s Love Shelter • Primary Health & Dental Care, Mental Health, Case Management & Medication Assistance Program • 6 Medical Providers, 1 Mental Health Provider, 1 Case Manager, 1 Diabetes Educator • Typically serve 6000 individuals per year • 20,000 encounters per year • EMR implemented in May 2009 • Telemedicine by end of 2010

4. President’s New Freedom Commission on Mental Health • Commission was created in April 2002 • Report submitted to President July 2003 www.mentalhealthcommission.gov/reports/reports

5. In a Transformed Mental Health System... • Goal 1 – Americans Understand that Mental Health is Essential to Overall Health. • Goal 2 – Mental Health Care is Consumer and Family Driven. • Goal 3 – Disparities in Mental Health Services are Eliminated. • Goal 4 – Early Mental Health Screening, Assessment, & Referral to Services are Common Practice. • Goal 5 – Excellent Mental Health Care is Delivered and Research is Accelerated. • Goal 6 – Technology is Used to Access Mental Health Care and Information.

6. Goal 4.4: Screen for Mental Disorders in Primary Care, across the lifespan and connect to treatment and supports. • This is where we fit in • Why was this Important to us? 70% of our patient population carries a mental health and/or chemical dependency diagnosis Very high rate of suicide in our community

7. Our Vision • Integrate Mental Health & Chemical Dependency Services into Primary Health Care • Received ORHP Grant in 2006 Hired staff, and developed a Community Consortium. The goal of the consortium was to increase patient access to psychiatric & CD services. Boyd Andrew Community Services Center for Mental Health

8. How We Proceeded • Fulltime LCSW and Case Manager hired in 2006 • LCSW provides brief, focused, cognitive behavioral therapy on site • Case Manager provides care coordination, resource & referral services • No wrong door – meet and greet • Our services are provided on the medical hall • Bridge to Boyd Andrew CS & Center for Mental Health

9. Reality vs. Vision The road to hell is paved with good intentions.

10. Our Efforts Met with Limited Success: • We inherited a grant that promised the moon and stars • Assumed level of support from staff • Boyd Andrew & Center for Mental Health had inadequate organizational commitment and service capacities

11. Data – Data – Data • The challenge to collect data • The challenge to demonstrate progress & outcomes • November, 2007 – Patient Tools implemented

12. Some of Our Findings • 2007 to present – 1100 screenings • Suicide ideation • Diagnostic Prevalence and Change (2008/2009) Major Depression 31% decrease PTSD 16% decrease Bipolar Disorder 30% decrease Generalized Anxiety Disorder 17% decrease Panic Disorder 35% decrease Chemical Dependency 65% decrease

13. Outcomes & Lessons Learned • Patients pleased with our services • One stop shopping • Services less stigmatized in medical setting • Patients like progress reports • Sustainability is complex… lots of support butlittle funding • We almost lost our jobs…

14. Received New ORHP Funding 2009! • This allowed us to continue and expand our Mental Health Program • We are now targeting CHC patients with co-morbid Diabetes & Mental Health Diagnoses to improve mental health and diabetes control.

15. If you have further questions, please contact us: Patrick Frawley, LCSW Mental Health Coordinator Cooperative Health Center 1930 9th Ave. Helena, MT 59601 (406)457-8982 pfrawley@co.lewis-clark.mt.us Rebecca Baraby Case Manager Cooperative Health Center 1930 9th Ave. Helena, MT 59601 (406)457-8983 rbaraby@co.lewis-clark.mt.us