Integrating Behavioral Health Into Safety Net Primary Care Settings Regional Policy Council Mental Health American Meeting February 19, 2016 - PowerPoint PPT Presentation

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Integrating Behavioral Health Into Safety Net Primary Care Settings Regional Policy Council Mental Health American Meeting February 19, 2016

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Title: Integrating Behavioral Health Into Safety Net Primary Care Settings Regional Policy Council Mental Health American Meeting February 19, 2016


1
Integrating 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

2
Overview of Presentation
  • HRSAs Investments in Behavioral Health
    Integration
  • Technical Assistance To The Field
  • Discussion Questions

3
HIV/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.

4
Maternal 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.

7
Bureau 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.

8
Federal 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).

9
Bureau 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.

10
Bureau 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.

11
How 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.
12
Key Concepts for Integration
  • Integrated Care Models
  • Workforce
  • Financing
  • Clinical Practice
  • Operations Administration
  • Health Wellness

13
Dedicated 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
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15
SAMHSA/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.

16
SAMHSA/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!

17
SAMHSA/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

18
SAMHSA/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/

19
Discussion 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
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