Evaluating Integrated Behavioral Health: A Tale of 8 Cities

Evaluating Integrated Behavioral Health: Objectives Describe at least two (2) integrated behavioral health models that are being implemented with a majority Hispanic population Identify at least two (2) methods of evaluating integrated behavioral health models Recognize at least one (1) innovative element in the Integrated Behavioral Health models delivered in these studies. Evaluating Integrated Behavioral Health: A Tale of 8 Cities

This Project is funded by:

What is ?

Poverty rate high as 40% Low educational attainment High rates of diabetes and behavioral health 39% of Hispanic population in South Texas area with Type 2 Diabetes also had Depression (ABFM, 2008).

Evaluation Evaluate IBH models to identify effective strategies to improve health outcomes for a high-poverty, majority Hispanic population with co-occurrence of physical and behavioral health conditions. Evaluation encompasses a rigorous multi-tiered strategy measuring:

What is Integrated Care?

Examples of Integrated Care IMPACT Model PEARLS Model Chronic Care Model Collaborative Care / Co-Location

Examples of Integrated Care Population focused strategies SBIRT Chronic Care Model Primary Care Behavioral Health Reverse Co-Location

Current Levels of Integration

Future Levels of Integration

Behavioral Health Model Primary Care Behavioral Health Model Implementing in 2 Family Medicine Residency Clinics Replicate the evidence based PCBH Model with Technical Assistance support from Dr. Patti Robinson and Dr. Kirk Strosahl PCBH: Increase access, Keep population healthy, educate and train the workforce of tomorrow (physicians and behavioral health providers) for Integrated care

Integrated Care in a Free Health Care Setting Mission: provide quality integrated services, including preventive care and education to medically indigent individuals & families living in the Rio Grande Valley. One Site From Co- Location to Integration Beginning Integration Level: 3 Target Integration Level: 6 Models: PCBH & Care Management Hope Family Health Center

Interfaces HOPE’s Integration Model Brief Therapy Project Assistant Brief Therapy Care Coordination with community providers for diabetes care (Salud y Vida), BH Crisis (LMHA), Eye Exams (DHR), Lifestyle Changes (MHM) etc. Onsite Long term Counseling Services Referral to Medical Specialists for procedures. Connection to Community Resources. Medical Assistant (MA) Care Coordinator Transitional Nurse Volunteer Medical Providers Behavioral Health Consultant

Primary Care Behavioral Health Model Started at Levels 3-4 of Integration Ultimate goal is a Level 5 of Integration

Disease Management Model TAMIU Disease Management Model Implementing in 4 outpatient Clinics [primary health and behavioral – mental health and substance abuse] Adapt elements of the evidence based DMM with assistance from network providers and TAMIU research team. DMM will allow us to increase access, fast track referrals, improve compliance, educate the population and further integrate behavioral health into the medical disease management processes.

Integrated Behavioral Health Model Implementing in 5 NCDV clinics Started at a Level 2 of Behavioral Health Integration Ultimate goal: Level 5 of Integration NCDV’s “One Stop Shop” Model Federally Qualified Health Center; 5 locations -NCDV’s hypothesis: IBH will improve control of chronic disease (obesity, diabetes, and hypertension), reduce depression, increase access to behavioral health services, and improve adult functioning and quality of life in the RGV

Integrated Behavioral Health Model Medical Provider Team based approach, increase of accessibility to services, seen as addressing one issue: health Nutritionist Behavioral Health Consultant NCDV’s One Stop Shop Model

-Non-randomized quasi experimental design-clinics designated as experimental and control

Measuring HbA1cs, BMI, Hypertension, Depression via PHQ-9 and Quality of Life via Duke

Integrated Behavioral Health Model Provide enhanced level of primary and behavioral health services offered through integrated health care delivery network: Salud Y Vida Control chronic disease Reduce depression Increase access to BH services Improve adult functioning and QOL most often from these co-morbid conditions.”   Integrated BH – 2 clinic partners for BH and Medication management; 6 community-based partners to implement peer led support groups and lifestyle programs

Reverse Co-Location Integrated Behavioral Health (IBH) Model TRIP for Salud y Vida, will offer eight enhanced integrated services. assignment of a navigator and case manager; assignment of a consumer attendant; home and telephone nurse assessments; development of an individualized transportation plan; coordination and delivery of transportation services to and from health care appointments; consumer enrollment in a community‐health worker led diabetes self‐management education (DSME) for the diabetes subgroup implementation of community based health and disease management classes tailored to consumer needs (i.e., physical activity, self‐management education, food and nutrition education).

Reverse Co-Location Integrated Behavioral Health (IBH) Model

Reverse Co-location Integrated Behavioral Health (IBH) Model TTBH’s program theory is that integrated Primary Care services… delivered to adult clients with Severe and Persistent Mental Illness (SPMI) and co-morbid chronic illness, from a clinic co-located within the outpatient Behavioral Health clinic … will lead to improved physical health and mental health for an increasing proportion of clients served. Notes: TTBH’s program theory outlined. Integrated BH level – working through improved communication and establishing process and continual education of staff in IBH

Questions & Discussion