Creating Recovery: Integrating Public and Behavioral Health Care

1
Creating Recovery Integrating Public and
Behavioral Health Care

• Mary Specio-Boyer MSW, LISAC, ADS
• COPE Community Services, Inc. Tucson, Az.
• April 2009

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Presentation Format

• Introductions
• Defining the need and benefit of integration
• Tools for Change Individual Level, Community
  Level and System Level
• Data and Resources
• Advancing the conversation special topics

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Who we are

• COPE Community Services provides behavioral
  health care to over 5000 clients a year.
• Services include addressing serious mental
  illness, substance abuse and HIV/AIDS prevention,
  gender-specific services
• They have run over ten federal grants in the last
  10 years including several collaborations focused
  on linking minority populations to services and
  homeless outreach
• They run several community mobilization projects
  and have supported several models of integrated
  care services

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Substance abuse and Communicable Disease Are
Related

• Directly through Intravenous Drug Use (IDU)
• Indirectly as partners of substance users
• People under the influence of alcohol and drugs
  are more likely to take risks, particularly meth
  users
• Substance abuse makes it less likely that someone
  will seek treatment for health care concerns

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Why integrate?

• Substance users are at high risk for HIV,
  Hepatitis and sexually transmitted disease
• They are at risk for rapid disease progression
• Stigma, concerns over self-disclosure, and
  transportation are serious barriers to access
• Drug use occurs within a social network where
  risk behaviors may increase the likelihood of
  contracting disease

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How can it help?

• Addressing the whole person rather than just a
  diagnosis can have far reaching positive impacts
  (dissemination of safety information, reduced
  healthcare costs) Better health outcomes and
  higher adherence levels are gained by integration
  of services
• HIV/STD testing is normalized by being a part of
  the care continuum
• You can reach beyond the individual
• You may be saving someones life by helping them
  get care or preventing them from illness

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Individual Level Change How can it be done?

• Get releases for other agencies from your clients
• By referral Know the people you are referring
  to by going out and meeting them. The health
  dept. has programs you may not even know about.
• By inviting the health care providers to your
  office for a screening day once a month
• By holding a health fair
• By becoming an educator on HIV prevention
• Offer to teach your clients to become HIV
  prevention educators

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Power of Community

• Create a community of providers and engage your
  clients in visiting all the services. Make a
  checklist
• Have a regular brown bag meeting with outside
  providers at your office
• Have a quarterly social event for your clients
  and their friends and loved ones to share their
  recovery stories
• Hold a group for your HIV positive clients to
  attend and discuss their issues, socialize
• Dont provide a service Create a community

9
System Level Change Lets Talk

• Change at the top can start at the bottom
• Integration and sustainability are about
  relationships
• Initiate conversation with administrators about
  the possibilities of
• Securing office space to ask other providers to
  offer services (HIV testing, Basic First Aid, TB
  screening) there on a scheduled basis
• Co-locating services
• Seeking collaborative funding

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Why wait?Resources and Data

• You can find data for your community at your
  State Health Department
• National data is available at the Centers for
  Disease Control and Prevention (CDC), and
  National Institutes for Drug Abuse (NIDA)
• The Substance Abuse Mental Health Services
  Administration (SAMHSA) funds initiatives to
  address these issues, and there are probably
  federal programs in your community you can link
  with
• Models of care are available on most of these
  websites

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Advancing the conversation

• Culturally Specific Interventions (cafecitos,
  house parties, indigenous leaders)
• Transactional Sex and Commercial Sex Work
• Disproportionate disease rates in communities of
  color
• Homeless individuals and where they seek help
• Risk-reduction and Abstinence How can they work
  together
• Co-occuring populations
• Interdisciplinary teams and differences in
  language
• Family-Based care