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

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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

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Overview of Presentation

• HRSAs Investments in Behavioral Health
  Integration
• Technical Assistance To The Field
• Discussion Questions

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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.

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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.

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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)

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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.

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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.

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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).
  

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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.

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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.

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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.
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Key Concepts for Integration

• Integrated Care Models
• Workforce
• Financing
• Clinical Practice
• Operations Administration
• Health Wellness

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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.
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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.

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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!

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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

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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/

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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?

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Contact Information

• Alexander F. Ross, Sc.D.
• [phone]
• Aross_at_hrsa.gov