Treatment Access and the Need for Diverse Treatment Approaches Eliminating Disparities Through Integrated Behavioral Health Care Teresa Chapa, Ph.D., MPA Executive Dean, CSPP May 25, 2016 Graphic: Seal of the university.

Presentation Goals This presentation will examine integrated health care as it applies to underserved racial and minority populations. We will examine Behavioral health disparities and barriers to care What integrated care is An understanding of integrated care for minority and limited English proficiency populations Building a culturally and linguistically competent, integrated healthcare team Current efforts toward building and strengthening integrated care approaches

U.S. Population Distribution by Race/Ethnicity 2015 Source: http://kff.org/other/state-indicator/dstribution-by-raceethnicity/

One in five Americans reports not having received, or that a family member has not received, mental health services. Percentage of respondents with the following answers to questions asked in April 2016: Source: Kaiser Family Foundation Health Tracking Poll: April 2016. Available at http://kff.org/report-section/kaiser-health-tracking-poll-april-2016-substance-abuse-and-mental-health/

Majors Barriers to Receiving Quality Behavioral Healthcare Services Lack of availability of care Inadequate care Poor quality of care Lack of evidence-based interventions Dissatisfaction with care Prohibitive costs of care

Utilization of mental health services is relatively low among African Americans, Asian Americans, and Hispanics. Annual average percent utilization by adults of mental health services in the past year, by race/ethnicity and service type, 2008–12 Source: SAMHSA (http://www.samhsa.gov/data/sites/default/files/MHServicesUseAmongAdults/MHServicesUseAmongAdults.pdf)

Persons with serious mental illness (SMI) are now dying 25 years earlier than the general population. Increased morbidity and mortality are largely due to treatable medical conditions that are caused by modifiable risk factors such as smoking, obesity, substance misuse, depression, and inadequate access to medical care (60 percent of premature deaths in persons with SMI are due to natural causes). Image: Burning cigarette propped against ashtray. Image: Various junk foods. Did you know??? Image: Gaucho holding lighted cigarette. 1. Overall health is essential to mental health. 2. Recovery includes wellness. 3. Recovery is possible!

Help-seeking delays lead to more chronic and disabling behavioral health conditions. Common reasons for delaying care: Lack of understanding about mental health and addictions. Unaware that services exist or where to receive them. Costs: No insurance coverage, or not enough coverage. Stigma (i.e., personal weakness, shame, fear of labels). Cultural differences in approaches to treatment (i.e., seek help from friends, pastors, curanderos…). Language barriers between consumer and provider. Distrust of provider community.

Health disparities exist. Factors affecting quality of health care: Primary care does not have expertise in providing behavioral health services, and behavioral health clinics do not have expertise in providing primary care. Provider shortages/network insufficiency. Lack of bilingual/bicultural medical and behavioral health providers. Few culturally competent services. Poor doctor–patient communication. Behavioral health conditions are among the most expensive to treat. What do we know??? Accurate screening, diagnosis and treatment are entirely dependent on a linguistically accurate interview.

Poor quality of care and inadequate or unsatisfactory care continue…. No usual source of care. Barriers with location and availability of services. Problems with accuracy of diagnoses. Poor timing of interventions, treatments, and services not available when needed. Missing care coordination. Few providers with cultural and linguistic competency.

Subhead

For many racial/ethnic minority populations, and those with limited English proficiency… Primary care settings are often the gateway to receiving health care and have become the portal for identifying undiagnosed or untreated behavioral health disorders. This observation opened the door to new approaches such as integrating behavior health care with primary care.

What Is Integrated Care? One definition that captures the principles and concepts of integrated care: “Integrated health care is the systematic coordination of physical and behavioral health care. The idea is that physical and behavioral health problems occur at the same time. Integrating services to treat both will yield the best results and be the most acceptable and effective approach for those being served.” — The Hogg Foundation for Mental Health

Subhead Miller BF, Kessler R, Peek CJ, Kallenberg GA. A National Agenda for Research in Collaborative Care: Papers From the Collaborative Care Research Network Research Development Conference. AHRQ Publication No. 11-0067. Rockville, MD: Agency for Healthcare Research and Quality. July 2011.

Need for Consistent Lexicon Researchers, system designers, quality improvement and performance measurement experts, policymakers, and consumers require a common language: Practice redesign shaped by Performance evaluation leading to Patient engagement; and sustained by Policy and business model change Source and definition: https://integrationacademy.ahrq.gov/lexicon

Integrated Care: A Key Strategy of the ACA Promote integrated behavioral health and health care through the Patient- Centered Medical Home: Coordinate care for patients’ total healthcare needs in a timely, personal manner that achieves measurable high-quality outcomes. Improve the quality of care. Address the social determinants of health. Establish functioning financial arrangements. Recruit and train a culturally and linguistically competent workforce. Use information technology for optimal communication among health professionals and patients.

Why Integrate Care? Our research shows that Latinos are most likely to seek all forms of care at the PRIMARY CARE SETTING.

Integrated Care Strategies to Potentially Eliminate Behavioral Health Disparities: Increase knowledge and implementation of integrated primary and behavioral healthcare models that serve racial and ethnic minority communities and those with limited English proficiency. Promote best, promising, and evidence-based practices that are culturally and linguistically appropriate. Support efforts to build a multidisciplinary, diverse, knowledgeable, bilingual, and culturally competent workforce and leadership for integrated care. Improve health and behavioral health care by addressing the role of social determinants of health. Improve information and best practices dissemination strategies through efforts such as learning collaboratives.

Intervention: Primary and Mental Healthcare Integration for Improved Access to Quality Care Whole health care. Cultural and linguistic competence. Patient centered. Consumer satisfaction. Comprehensive care. Coordinated systems of care. Use of health information technology. Normalize mental health in primary care. Prevention and early intervention. Early diagnosis and treatment. Effective identification and treatments of co-morbidities.

Integrated Care Principles Team-based care: Patient/Family NP/PA RN/LPN Medical Assistant Office Staff Care Coordinator Nutritionist/Educator Pharmacist Behavioral Health Case Manager Social Worker Community resources CHWs/Promotores Others… Personal healthcare provider Behavioral health practitioner Whole person orientation Enhanced access to care Coordinated care through integration Quality and safety Payment to support

Enhancing the Delivery of Health Care: Eliminating Health Disparities Through a Culturally and Linguistically Centered Integrated Health Care Approach

Integrated Health Care: National Platform The Affordable Care Act Academy for Integrating Behavioral Health and Primary Care, Agency for Healthcare Research and Quality Primary and Behavioral Healthcare Integration Program: Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Integrated Care Solutions (SAMHSA and Health Resources and Services Administration) Healthcare Innovation Awards, Centers for Medicare and Medicaid Services U.S. Department of Health &Human Services’ Office of Minority Health American Psychological Association Council on Social Work Education Hogg Foundation for Mental Health

If Not Now, When? The train is leaving—has left the station! Health disparities persists. ACA driving system change. Increased demand for the TRIPLE AIM! Improve outcomes, enhance the patient experience of care, and decrease the cost. What does this mean for you? Improve efforts to strengthen and expand culturally and linguistically competent care. Opportunity to be part of a NEW system of care to address the whole health needs of patients/consumers. Develop new partnerships. Opportunity to educate and train a new cadre of health and behavioral health providers to work in IC settings. Image: Steam train approaching.

California School of Professional Psychology Contact Information Teresa Chapa, Ph.D., MPA Executive Dean California School of Professional Psychology 10455 Pomerado Road San Diego, CA 92131 Teresa.Chapa@Alliant.edu