New and Emerging Services and Primary Care, Behavioral (MH/SA) Health Initiative

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New and Emerging Services and Primary Care,
Behavioral (MH/SA) Health Initiative

• Presented by
• Kathleen Reynolds, Director of CIHS

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PBHCI SAMHSA/HRSA Center for Integrated Health
Solutions Grant

• 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

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National Steering Committee
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Primary Behavioral Health Care Integration
(PBHCI) Program - Grantees

• Program purpose
• To improve the physical health status of people
  with SMI by supporting communities to coordinate
  and integrate primary care services into publicly
  funded community-based behavioral health
  settings, including substance abuse service
  organizations
• Expected outcome
• Grantees will enter into partnerships to develop
  or expand their offering of primary healthcare
  services for people with SMI, resulting in
  improved health status
• Population of focus
• Those with SMI served in the public behavioral
  (MH/SA) health system

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Top Ten Areas for Consideration in Developing and
Supporting Patient Centered Health Care Homes

• State Level Leadership
• State Level Management
• Models/Strategies
• Culture
• Workforce

• Collaboration
• Confidentiality
• Finance
• Data
• Training

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State Level Leadership

• Identify overarching vision and language for
  discussions
• Language (coming soon)
• Wagner Chronic Care Model
• Four Quadrant Model
• Doherty/Baird/Reynolds Continuum

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• Language Document In Press Available within
  30 days

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The Consumer and Staff Perspective/Experience
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Wagner Chronic Care Model
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Four Quadrant Clinical Integration Model
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State Level Management

• Using overarching structure What do you expect?
• This time we need disruptive innovation not
  paying for what we already do. What will be
  different and how will you know that changes are
  good change?
• How do you envision substance abuse services to
  be involved in the Health Home?

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Models/Strategies Bi-Directional 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)

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Models/Strategies for Involving/Integrating
Substance Abuse Services

• Wisconsin and UCLA SBIRT Program
• Baltimore Two FQHCs integrating co-occurring
  services into primary care
• Connecticut Methadone Program became primary
  care site
• Philadelphia Horizon House
• Medication Assisted Treatment Options

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Projects by State

• Alaska Wrangell Community Services
• Arizona CODAC Behavioral Health Services
• California
• Mental Health Systems
• Alameda Co Behavioral Health Care
• Services
• Asian Community MH Services
• San Mateo County Health Services
• Agency
• Tarzana Treatment Centers, Inc.
• Colorado
• Mental Health Center of Denver
• Connecticut
• Bridges A Community Support System
• Community MH Affiliates
• Florida
• Coastal Behavioral Healthcare
• Lifestream Behavioral Center
• Miami Behavioral Health Center

• Indiana
• Adult and Child Mental Health Center
• Southlake Community Mental Health Center
• Centerstone of IN
• Kentucky Pennyroyal Regional MH/MR Board
• Maine Community Health and Counseling Services
• Maryland Family Services, Inc.
• Massachusetts Community Healthlink, Inc.
• Michigan Washetenaw Community Health
  Organization
• New Hampshire Community Council of Nashua
• New Jersey
• CarePlus NJ
• Catholic Charities Diocese of Trenton
• New York
• VIP Community Services
• Postgraduate Center for Mental Health
• Bronx-Lebanon Hospital Center
• International Ctr for the Disabled
• Fordham Tremont CMHC

• Pennsylvania
• Milestone Centers
• Horizon House
• Rhode Island
• Kent Center for Human/Org Development
• The Providence Center
• Texas
• Austin-Travis CO MH/MR Center
• Lubbock Regional MH MR Center
• Montrose Counseling Center
• Utah
• Weber Human Services
• South Carolina State Dept of MH
• Washington
• Asian Counseling and Referral Services
• Downtown Emergency Service Center
• West Virginia Prestera Center for MH Services

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Culture

• Acknowledge the differences between MH/SA/PC
  cultures
• Do not allow it to deter or delay implementation
• Address it through training
• On the job training
• Existing resources
• Joint grand rounds
• Webinars
• Train together and separately
• Provide support for moving forward

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Workforce

• Existing Workforce Needs
• Reviewing and Credentialing standards
• Substance Abuse Professionals Treatment and
  Prevention
• Mental Health Staff
• Who? Can do What? Where?
• Licensing Standards - Space
• Scope of Practice Standards
• Advanced Nurse Practitioners
• Future Work Force
• Linkages with training programs

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Collaboration

• Does this come naturally in your state?
• Does your strategy support creating or breaking
  down silos?
• Does your strategy make use of the solid
  investments in existing systems and take
  advantage of their strengths?
• Will you system pay for or support collaboration
  for systems and for services now and in the
  future?
• How has MH/SA collaboration/integration gone in
  your state?

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Confidentiality

• HIPAA allows for sharing information for Health
  Care Coordination
• 42CFR Part II Issues may impeded information
  sharing
• Does your state mental health code need revising?

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Products at levels one, two, three, and four
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Finance

• Existing Options
• 96100 series
• SBIRT codes
• Case Management Reimbursement
• Dear Medicaid Director 2005
• Future Options
• Healthcare Home expanded reimbursement options
• Include what we know works!

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Data

• What existing data can you develop/share with
  pilots sites?
• Medicaid Data Based Integrated for MH, SA and PC?
• What are the costs per consumer?
• Is it available electronically?
• What will you want in the future?
• How will you know if you are successful?
• Do you have registry option for providers?

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Training

• Keys to success
• Change management training
• Collaborative service provision like
  professionals train like professionals
• Health Navigator Training
• BH staff (MH and SA) in primary care
• PC staff in mental health and substance abuse
  agencies

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CIHS Services to Assist You

• Web-based Resource Center (http//www.centerforint
  egratedhealthsolutions.org)
• eSolutions Newsletter
• National Webinars
• Regional and State Based Learning Communities