Alaska Island Community Service Primary and Behavioral Health Care Integration Alaska Island Community Services Cohort II Learning Community Region 1 Wrangell, Alaska Desiré Shepler

About Our Program Integration Model – Alaska Island Community Services Partners with Petersburg Mental Health Services and Petersburg Medical Center. In Wrangell medical and behavioral health services are provided in the community by Alaska Island Community Services. Medical and behavioral health services are not co-located. In Port Protection, Point Baker, Naukati, Whale Pass, Coffman Cove, and Edna Bay itinerant medical and behavioral health services are provided by Alaska Island Community Services. In Petersburg, medical services are provided by Petersburg Medical Center and behavioral health services are provided by Petersburg Mental Health Services. These agencies are in the community and are not co-located. Strategies To Incorporate Primary Care – Increase communication between behavioral health and primary care providers: Create forms to convey needed behavioral health information to the primary care staff at referral. Project staff communicate with Petersburg Medical Center and Alaska Island Community Services medical clinic administrative staff weekly to coordinate project efforts needed in the upcoming week. Behavioral health providers and call primary care providers regularly to ensure relationships exist between the providers that encourage integration of care for their shared clients. Enrollment Target – The Alaska Island Community Services Primary and Behavioral Health Care Integration Program has an enrollment target of 75 for program year two.

About Our Program Wellness Services – AICS continues offering twice monthly activities that combine exercise and nutrition education. Activities are 1 ½ hrs. long: 1 hour of exercise and ½ hour of nutrition education and eating. – PMHS offers weekly Walleyball games, once weekly one-on-one cooking classes, and a bi-weekly potluck where each enrollee brings a healthy dish he/she has cooked at home. – Both AICS and PMHS offer free access to Parks and Recreation facilities, including the gym and swimming pools, for PBHCI enrollees in their respective communities. AICS also offers PBHCI enrollees free access to all of the activities offered by Parks and Recreation in Wrangell. Agency staff accompanies clients to activities as needed in both communities. – Activities in both communities are consumer driven. – Peers continue to co-facilitate wellness activities in each community. EHR Vendor is NextGen All service area communities are island communities, accessible only by air and water. There is one commercial flight into and one out of Wrangell and Petersburg each day and limited ferry service. Prince of Wales communities are accessible only by private or chartered air or water transportation. The geographic area covered by this project comprises over 16,011 square miles and has a total population of 6,387, for a population density of 2.5 people per square mile.

Who We Are Alaska Island Community Services Desiré Shepler, MPH Project Director Krissy Smith, MS Wellness Coordinator Linda McElroy, BS Administrative Assistant Mark Walker, MSW AICS Executive Director All AICS team members are employees.

Engaging Peers Recruit as co-facilitators peers who were already involved in wellness related activities in their communities. In our small communities, these are people already recognized as knowledgeable about health and wellness topics. All 3 originally trained peers continue to co-facilitate wellness activities in both Wrangell and Petersburg. Peers outreach to program enrollees to gather information on the direction enrollees would like to see wellness activities take. Peers work with enrollees on a one-on- one basis and in group settings to teach nutrition education and to lead physical activities Two of the peers were known in their communities for their work as physical fitness instructors before becoming involved in this project. Enlisting the assistance of peers with a background in physical fitness made it very comfortable for enrollees to talk with the peers about issues around physical fitness and wellness in general. Enrollees also value the advice of the peers as the enrollees are comfortable that the peers “know what they are talking about”. This set-up also ensures that the peers (who work with the program on a volunteer basis) remain engaged in the work as they are passionate about helping others to be healthy.

Wellness Activities Continually work to incorporate enrollee feedback into the development of wellness activities. In Wrangell, wellness activity enrollees are asked at each physical fitness activity about what activity they would like to participate in in the upcoming meeting. In Petersburg wellness program physical fitness activities are more long standing. For example, in the summer, a walking group met regularly for months. Beginning in January 2012, the walking group was replaced with regular Walleyball games. In both communities individuals who participate in the nutritional education activities are also surveyed regularly. In Wrangell, nutrition education continues to be delivered on a group basis, in Petersburg participants have requested a revised format that includes one-on-one education and group activities. For enrollees who, upon being surveyed, express a lack of interest in group physical fitness activities wellness program staff coordinate one-on-one physical fitness routines that work for the individual. This is accomplished thanks in part to a working relationship with the Parks and Recreation departments in both communities. When wellness activity attendance began dropping in winter 2011 Petersburg staff cancelled all activities through the start of January During that time staff surveyed attendees to ask about changes they would like to see in the wellness activity programming in the new year. Both physical activities and nutritional education activities were revised accordingly, and when programming began again in January attendance rates were up once again.

HIT AICS partners with Alaska Primary Care Association to combine funding for custom behavioral health template development with NextGen EPM and EMR. Professional firm selected, Medicalistics, is the NextGen content partner for behavioral health KBM. Ability to collaborate with Medicalistics on foundation for NextGen behavioral health content development for next KBM releases. Ability to collaborate on custom behavioral health template development with other FQHC’s in Alaska using NextGen. Behavioral health templates produced will be in alignment with future releases and will not require as much maintenance. Behavioral health templates produced will be in alignment with future releases and will not require as much maintenance. The SAMHSA funding combined with other funding sources will create a better product that won’t require as much future funding to maintain.

Plans For The Future Sustainability – Clinical Adopt a whole person health plan as part of every behavioral health treatment plan. – Administrative Expand weekly meetings of project staff to include a primary care provider. – Financial Explore alternative methods to acquire low-cost blood glucose and blood lipid tests to make annual blood tests more affordable. Recently Alaska Island Community Services received a state grant to implement a patient centered medical home. The expectation is over the next two years the State of Alaska will develop enhanced reimbursement for coordination and case management services that may be applied to the necessary services relevant to the PBHCI clients. In the next six months we will co-locate behavioral health and primary care staff in Wrangell at Alaska Island Community Services’ new primary care clinic.