A Partner In a thousand of journeys of Recovery, Healing and Transformation of people with a mental health challenge to live a meaningful life in a community While striving to achieve his or her full potential. ACRS Behavioral Health Program

1,700 served annually 85% speaks a language other than English. 17 different languages and dialects (Mandarin, Cantonese, Taiwanese, Cambodian, Korean, Japanese, Tagalog, Ilocano, Lao, Mien, Hmong, Vietnamese, Samoan, Burmese, Chin, Bhutanese, Nepali) 91% were not born in the US. 95.2% “low-income” and “very low income.” 25% have no health coverage ACRS Behavioral Health Clients

Client Diagnosis: –Depression: 45% –PTSD and adjustment disorder: 17% –Schizophrenia or other psychotic disorder: 16% –Bipolar: 8% –Anxiety or phobia: 4% –Organic disorders including dementia: 3% Over 500 with a psychotic disorder, psychotic features in Depression, PTSD or other disorder, on psychotropic meditation and at higher risk for metabolic syndromes ACRS Behavioral Health Clients

Lower use of most health care services Poorer patient-provider relationship with the PCP Hepatitis B: APAs account for over half of all chronic hepatitis B. One in ten infected with the hepatitis B virus (HBV) Diabetes: 20% Native Hawaiians; 47% America Samoans Cancer: 2X Cases, 2X Death rate due to cancer Vietnamese women: 5X more likely to be diagnosed with cervical cancer APA Health Disparity - Medical

Cardiovascular disease is the second leading cause of death Breast cancer is the second-leading cause of cancer death among APA women Lowest rates of mammography and clinical breast exam (CBE) screenings Higher prevalence of chronic liver disease and liver cancer Worst oral health indicators of any racial/ethnic group APA Health Disparity - Medical

56% at risk for Blood Pressure 70% at risk for Diabetes 67% at risk for Cholesterol ACRS Behavioral Health Clients Health Condition

People with serious mental illness (SMI) die on average at the age of 53 years old

VISION – Healthy people, stronger families, vibrant communitiesVISION – Healthy people, stronger families, vibrant communities MISSION – ICHS provides culturally and linguistically appropriate health services to improve the health of Asian Pacific Islanders and the broader community.MISSION – ICHS provides culturally and linguistically appropriate health services to improve the health of Asian Pacific Islanders and the broader community. CORE VALUES : TEAMCORE VALUES : TEAM MEDIC aking a difference Making a difference xcellence Excellence iversity Diversity ntegrity Integrity ustomer Service Customer Service

A person-centered, collaborative, culturally competent, community-based care system of primary health services, wellness education and activities for underserved, at-risk, limited English proficient (LEP) Asian Pacific American immigrants and refugees with a Serious Mental Illness. In partnership with International Community Health Services, a primary care provider and Federally Qualified Health Center (FQHC) WAPA (SAMSHA funding )

WAPA Goals 1: To increase access to primary health care services by providing primary care service at ACRS outpatient mental health setting. 2: To promote healthy living through an array of culturally competent wellness-education and support services.

Transformation from Mental Health Service to Wellness Service. Mind and body working together. Day activities program is Wellness Program Exercise, movement, dance are a part of all group activities Primary care needs are followed from intake to exit Integration and coordination among PC staff and psychiatric staff Over 500 clients participating in the project Paradigm Shift

Onsite PCP services provided by external ICHS team include Preventive care, Health screening, treatment, EKG, blood draws, specialty care referrals Primary Care Services

Health and wellness education and support activities including nutrition, diet, exercise program. Blending of Eastern approaches: Acupuncture, Tai Chi, Yoga, Meditation 15 different Wellness groups with more than 300 clients participating: Tai Chi, Yoga groups, Asian Zumba, Ethnic Wellness groups (Mien, Lao, Samoan, Cambodian, Vietnamese), Cambodian Elders group, two gardening groups, walking, Healthy Cooking, ping pong, traditional dance, and Karaoke group. Incentive system to encourage participation. Fun and culturally relevant activities. Culturally Relevant Wellness Activities

Dental Service through Dental Mobile Van from Medical Teams International Diabetes focused Wellness Groups Focus on smoking cessation and Tobacco free campus. Acupuncture Other Components

Staffing from the Partnership 35 bilingual Behavioral Health Case Manager as Care Manager and Wellness Educator, Wellness Group Lead. ACRS staff 8 Psychiatric Medical StaffACRS staff 1 Wellness Nurse and EducatorACRS staff 3 designated Wellness Specialists.ACRS staff 2 Peer SpecialistsACRS staff 1 Acupuncturist and 4 Acupuncturist student internsACRS contractor 1 Tai Chi, 1 Yoga, 1 Asian Zumba instructor, 1 Art TherapistACRS contractor 3 ACRS Project Management TeamACRS staff 2 Primary Care ProvidersICHS staff 2 Medical AssistantsICHS staff 1 Eligibility Worker, medical service coordinatorICHS staff 2 ICHS Project Management teamICHS staff

November 2008 Integrated care between bilingual Behavioral Health Care Manager, Psychiatric staff and PCP Care manager acts as interpreter, cultural broker, consultant, health educator, provides intensive follow-up, promotes coordination among involved parties, and leads the development of a integrated person-centered wellness plan. Behavioral Health Care Managers

Baseline Comparison of health risk ACRS clients At risk Whites At risk BMI58%78% Cholesterol62%46% Blood Pressure56%42% Diabetes70%55% Cholesterol63%46%

Initial Health Outcomes From Baseline to reassessment Based on 250 clients with health indicator information at intake and at 6-month follow up. At risk at Baseline At risk at Reassessment Outcome Improved Blood Pressure56%52%23% BMI57%54%49% Waist circumference 55%57%43% Diabetes70%69%42% Cholesterol63%59%31%

November 2008 Transformation! It is now Wellness program, not just Mental Health program!! Partnership with ICHS with shared vision Care Manager and Health Home model Health Education to Mental Health Case Managers Cultural Competency Building Community Sustainability Plan Ingredients for Success