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Mental Health and Physical Health: Barriers to and Strategies for Improved Integration

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Title: Mental Health and Physical Health: Barriers to and Strategies for Improved Integration


1
Mental Health and Physical Health Barriers to
and Strategies for Improved Integration
Beth Zimmerman and Renee Schwalberg Health
Systems Research, Inc. National Policy Center for
CSHCN AMCHP Annual Meeting March 27, 2001
2
Who Are We Talking About?
  • Children with Special Health Care Needs
  • General population of children

3
Context
  • Importance of service integration for CSHCN
  • Previous studies highlighted fragmentation
    between mental and physical health
    services/systems
  • Timely Issue
  • Surgeon General Report on Mental Health

4
Study Focus
  • Purpose of Study Glean lessons about
    fostering service integration that can be
    applied in other states/communities
  • Target Audience Child health, mental health,
    health care financing communities
  • Intended Use Promote integration between
    physical and mental health service delivery
    systems

5
HSR Study Approach
  • Expert Meeting (October 2000)
  • Case Studies (Early 2001)
  • Reconvene Expert Advisors (April 2001)
  • Final Report (May 2001)

6
Research Question Domains
  • Barriers and Strategies
  • Services and Delivery Systems
  • Financing

7
Case Study Sites Criteria
  • Program maturity
  • Diversity of
  • Program model
  • Strategies used for integrating services
  • Source of financing
  • Target population
  • Location

8
Case Study Sites
9
Primary Integration Strategies
  • Cross-Jurisdictional Interagency
    Relationships
  • Care Coordination
  • Information Sharing
  • Shared Financing

10
Integration Strategy Cross-Jurisdictional
Interagency Relationships
  • Multiple and diverse agency relationships cut
    across jurisdictional lines
  • Challenge of reconciling different agency
    mandates and cultures
  • Win/Win situation

11
Integration Strategy Care Coordination
  • Central strategy to promote integration
  • Local situation drives care coordination
    model
  • Family involvement defining feature

12
Integration Strategy Information Sharing
  • Clinical Records
  • Informal sharing
  • Formal sharing
  • Program/Fiscal Management

13
Integration Strategy Shared Financing
  • Role of grants in launching integration
    efforts
  • Longer term funding required
  • Numerous relevant funding streams
  • Challenge of blending diverse funding streams
    to accomplish common goals

14
Conclusions
  • Recognition that multiple agencies serve the
    same children
  • Importance of shared decision making
    structures at all levels
  • Leadership to move ahead
  • Participation of high-level decisionmakers
    with authority to make and keep commitments

15
Conclusions (contd)
  • Ongoing involvement of planners in
    implementation and monitoring
  • Structure for and commitment to nurturance
    and problem-solving
  • Importance of evaluation to show return on
    investment

16
Next Steps
  • Finalize Report
  • Timeline End of May 2001
  • National Center for Children with Special Health
    Care needs Web Site
  • www.jhsph.edu/centers/cshcn
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