Title: Integrating Behavioral Health Into Safety Net Primary Care Settings Regional Policy Council Mental Health American Meeting February 19, 2016
1Integrating Behavioral Health Into Safety Net
Primary Care SettingsRegional Policy Council
Mental Health American MeetingFebruary 19, 2016
- Alexander F. Ross, Sc.D.Senior Behavioral Health
Advisor - Office of Planning, Analysis and Evaluation
- Health Resources and Services Administration
- U.S. Department of Health and Human Services
- Aross_at_hrsa.gov
2Overview of Presentation
- HRSAs Investments in Behavioral Health
Integration - Technical Assistance To The Field
- Discussion Questions
3HIV/AIDS Bureau
- The Ryan White HIV/AIDS Program provides primary
care, support services, - and medications.
- Reaches 500,000 people living with HIV (more than
half of all people living with diagnosed HIV
infection in the United States). - Mental Health Services were provided by almost
75 of Ryan White HIV/AIDS provider organizations
/substance abuse services were provided by almost
34 of Ryan White HIV/AIDS provider organizations
(CY 2014). - Noteworthy Resources
- Integrating Mental Health and Substance Abuse
Care into HIV Primary Care Toolkit (AETC National
Resource Center). - AIDS Education and Training Centers (AETCs) -
Integrating Care through the Use of Screening and
Brief Intervention in HIV Settings - Pacific
AETC.
4Maternal and Child Health Bureau
- The Maternal and Child Health Bureau (MCHB)
provides leadership, with key stakeholders, to
improve the physical and mental health, safety
and well-being of women, infants, children,
adolescents, and their families, including
fathers and children with special health care
needs. - Key Programs
- HRSA Healthy Start- 100 Healthy Start sites
provide Educational Activities for Women in Areas
with High Infant Mortality and Shortages of
Health Care Providers - Community-Based Outreach/Case Management
- Behavioral Health Screening
- Maternal, Infant, and Early Childhood Home
Visiting Program - Funds States, territories and tribal entities to
provide evidence-based home visitation services
to improve outcomes for children and families who
reside in at-risk communities. - Bright Futures Guidelines (Initiated by MCHB)
https//brightfutures.aap.org/Pages/default.aspx - Comprehensive Clinical Preventive Services
covered by the Affordable Care Act. - Preventive services include Oral Health,
Behavior Health, Social Determinates of Health.
5 Bureau of Primary Health Care
- Over 1,200 health centers operate more than 9,000
service delivery sites that provide care to over
22.8 million patients in every state, DC, Puerto
Rico, the U.S. Virgin Islands, and the Pacific
Basin. - Behavioral Health Service Delivery
- Almost 69 of health centers provide mental
health treatment or counseling services on-site.
In 2014, there were over 13 million mental health
visits. - 36 of health centers provide substance abuse
counseling and treatment on-site. In 2014, there
were over 4 million visits for substance abuse
services. - More than 7,200 behavioral health providers
(physicians, psychologists, LCSW, counselors,
etc.) work in health centers (2014). - (Data Source UDS 2014)
6 Bureau of Primary Health Care
- Behavioral Health Integration Awards (BHI)
- Purpose BHI awards will improve/expand the
delivery of behavioral health services through
integrated primary care-behavioral health at
existing Health Center Program grantee sites. - Program Overview
- Total awards 436 awards
- Maximum of 250,000 per award
- Project period August 1st, 2014 July 31st,
2016. - Grant Requirements
- Increase in the number of patients screened via
Screening, Brief Intervention, - and Referral to Treatment (SBIRT)
- Hire 1.0 FTE licensed behavioral health provider
- Propose and implement an integrated care model.
7Bureau of Primary Health Care
- FY 2016 Substance Abuse Expansion Grants
- Purpose Improve and expand the delivery of
substance abuse services in existing health
centers, with a focus on Medication-assisted
Treatment (MAT) in opioid use disorders - Program Overview
- Total awards 310 expected awards
- Maximum of 325,000 per award
- Project period March 1, 2016 - February 28, 2018
- Application Review in progress
- Grant Requirements
- Establish or enhance an integrated primary
care/behavioral health model - Increase the number of patients screened for
substance use disorders - and connected to treatment via SBIRT and
other evidence-based practices - Increase the number of patients with health
center-funded access to MAT - Coordinate services necessary for patients to
achieve and sustain recovery - Provide training and educational resources.
8Federal Office of Rural Health Policy
- Advises the Secretary of the U.S. Department of
Health and Human Services on health care issues
impacting rural communities. - Helps increase access to care for underserved
populations and build health care capacity
through several programs. - Rural Opioid Overdose Reversal Program
- 18 grantees 100,000 for one year to develop
community-level partnerships comprised of EMS,
schools, fire departments, police departments,
and other private /public non-profit entities
involved in the prevention and treatment of
opioid overdoses. - Rural Health Care Services Outreach Grant Program
- Supports innovative health care delivery systems
in rural communities requires grantees to form a
consortium with at least two additional partners
13 outreach grantees focused on mental health
and/or substance abuse (FY 2015). - Publications-Behavioral Health and Substance Use
in Rural America www.ruralhealthresearch.org/ - Rural and Frontier Mental and Behavioral Health
Care Barriers, Effective Policy Strategies, Best
Practices - Integrating Primary Care and Mental Health
Current Practices in Rural Community Health
Centers - Rural-Urban Chartbook - provides a rural-urban
analysis on numerous health indicators and
outcomes, including prevalence of mental illness,
substance abuse treatment (2014 update).
-
9Bureau of Health Workforce
- The Bureau of Health Workforce increases access
by developing, distributing and retaining a
diverse, culturally competent workforce helping
health professions training programs address some
of the most pressing needs across the health
workforce. - Training Grants Health Professions/Nursing
Workforce - Behavioral Health Focus
- Graduate Psychology Education Grant/Behavioral
Health Workforce Education and Training Programs
- Internships/Field Placements to strengthen the
clinical field competencies of social workers
and psychologists who pursue clinical service
with high need and high demand population - Area Health Education Centers enhance access to
high quality, culturally competent health care
through academic-community partnerships to
improve the distribution, diversity, and supply
of the primary care health professions workforce
serving in rural and underserved health care
delivery sites. - National Center for Workforce Analysis provides
modeling, - and data collection to project current and
future workforce - demands newly funded Behavioral Health
Workforce - Analysis Center.
10Bureau of Health Workforce
- The National Health Service Corps (NHSC)
- The NHSC recruits fully-trained professionals to
provide culturally competent, interdisciplinary
primary health and behavioral health care
services to underserved populations. - NHSC programs assist in the professionals'
repayment of qualifying educational loans that
are outstanding. - 87 of NHSC clinicians continue to practice in
underserved areas up to two years after they
complete their service commitment. - In fiscal year (FY) 2015, over one in three NHSC
clinicians (3,371 out of nearly 9,683 as of
September 2015) provided mental and behavioral
health services. - Psychiatrists, Psychiatric Physician Assistants,
Psychiatric Nurse Practitioners, Health Service
Psychologists, Licensed Clinical Social Workers,
Licensed Professional Counselors, Marriage and
Family Therapists, and Psychiatric Nurse
Specialists.
11How Best To Integrate Care?That Depends
Minimal collaboration. Providers work in
separate facilities, have separate records
systems, and communicate sporadically. Basic
collaboration at a distance. Providers have
separate systems at separate facilities, but
engage in periodic communication about shared
patients. Basic collaboration on-site.
Providers from separate organizations have
separate systems but are co-located/share a
facility. Source Standard Framework for Levels
of Integrated Healthcare, SAMHSA/HRSA Center.
12Key Concepts for Integration
- Integrated Care Models
- Workforce
- Financing
- Clinical Practice
- Operations Administration
- Health Wellness
13Dedicated to promoting the development of
integrated primary and behavioral health services
to better address the needs of individuals with
mental health and substance use conditions,
whether seen in specialty behavioral health or
primary care provider settings.
14(No Transcript)
15SAMHSA/HRSA Center for Integrated Health
Solutions
- Mission of the Center To Build Bidirectional
Integration - Technical Assistance and Training Center on
Primary and Behavioral Health Integration. - Improving Access to Primary Care for Behavioral
Health Patients. - Improving Access to Behavioral Health for Primary
Care Patients. - Contractor - National Council on Community
Behavioral Health Care and a large cadre of
partners.
16SAMHSA/HRSA Center for Integrated Health
Solutions
- www.integration.samhsa.gov
- Target Populations
- SAMHSA Primary Behavioral Health Care
Integration (PBHCI) Grantees - HRSA Grantees
- General Public
- Services
- Knowledge Development (including training
curriculum) - Prevention and Health Promotion/Wellness
- Workforce Development
- Direct Technical Assistance
- Training Curricula
- White Papers and Factsheets
- eSolutions Newsletter sign up!
17SAMHSA/HRSA Center for Integrated Health
Solutions
- Use the Quick Start Guide to Behavioral Health
Integration to walk you through some of the
questions to consider when integrating primary
care and behavioral health and find the resources
your organization needs. www.integration.samhsa.go
v/resource/quick-start-guide-to-behavioral-health-
integration - Use the Standard Framework for Levels of
Integrated Healthcare to understand where your
organization is on the integration continuum.
www.integration.samhsa.gov/resource/standard-frame
work-for-levels-of-integrated-healthcare - The Core Competencies for Integrated Behavioral
Health and Primary Care provide a reference for
the vision of an integrated workforce and the six
categories of workforce development so you can
have all the necessary providers around the
table. www.integration.samhsa.gov/workforce/core-
competencies-for-integrated-care - Advancing Behavioral Health Integration Within
NCQA Recognized Patient-Centered Medical Homes.
www.integration.samhsa.gov/search?querypcmh
18SAMHSA/HRSA Center forIntegrated Health
Solutions
- Telebehavioral Health Learning Collaborative
- Divided into six sessions, the training will
provide you with the tools and resources
necessary to identify and implement a
telebehavioral health program. - What Makes for an Effective Behavioral
Health/Primary Care Team - Reviews team development within effective
integrated primary and behavioral healthcare
teams. The full review identifies four essential
elements for effective integrated behavioral
health and primary care teams and provides a
roadmap for organizations designing their own
teams - Billing/Coding Worksheets
- CIHS compiled these state billing worksheets to
help clinic managers, integrated care project
directors, and billing/coding staff bill for
services related to integrated primary and
behavioral health care. - Return on Investment Can I Afford Behavioral
Health Staff? - Addresses the business case for integration of
behavioral health into primary care and provides
guidance on how to evaluate this business case at
an individual Community Health Center.
-
Find all resources at
www.integration.samhsa.gov/
19Discussion Questions
- What works in building effective referral
arrangements primary care to behavioral health
settings and vice-versa? - Do you know examples of effective community-wide
planning for behavioral services? How does data
play a role in any of those examples? - From your perspective, what are some important TA
needs regarding the integration of behavioral
health and primary care? - How are you maximizing existing workforce to meet
the demand for integrated care?
20 Contact Information
- Alexander F. Ross, Sc.D.
- (301) 443-1512
- Aross_at_hrsa.gov