1. Addressing the Behavioral Health Needs of Cook County Residents
Douglas Elwell, Deputy CEO for Finance and Strategy
Cook County Health and Hospitals System
June 22, 2017

2. Learning Objectives
Learn about the strategies the Cook County Health and Hospitals System (CCHHS) has undertaken to integrate behavioral health, including mental health and substance use services, into primary care settings
Share progress of initiatives to connect justice-involved individuals with behavioral health services, in an effort to reduce recidivism and improve health outcomes
Share best practices and challenges

3. Presentation Outline
Overview of Cook County Health and Hospitals System
Behavioral Health Needs
CCHHS Initiatives
Lessons Learned
Questions?

4. Overview of Cook County Health and Hospitals System

5. Cchhs mission
To deliver integrated health services with dignity and respect regardless of a patient’s ability to pay;
To foster partnerships with other health providers and communities to enhance the health of the public;
And to advocate for policies which promote and protect the physical, mental, and social well-being of the people of Cook County.

6. CCHHS Facilities CCHHS is comprised of four major component parts:
Provider - we have a broad geographic network of that includes two acute-care hospitals, a robust network of community-based clinics providing a robust array of services including behavioral health.
Correctional Health – we provide health services for detainees of both the Cook County Jail and the Cook County Juvenile Temporary Detention Center,.
Public Health – we provide public health services in suburban Cook Couny.
Plan – we own and operate CountyCare, our Medicaid managed care health plan.

7. Annual utilization at CCHHS
300,000+ unique patients
914,000 outpatient clinic registrations
5 million lab tests performed and analyzed
1.9 million outpatient prescriptions filled annually
55,000 intake screenings at Cook County Jail
46,000 visits to the Ruth Rothstein CORE Center, one of the largest HIV treatment providers in the nation

8. Behavioral Health Needs of Illinois and Cook County Residents

9. State and local data
43% of women and 34% of men in Illinois reported poor mental health status1.
About 5.4% of the population of Illinois had a serious mental illness in 2012, and 16.7% of adults in Chicago had been diagnosed with a depressive disorder in
Only 55.1% of children (ages 2-17) with emotional, developmental, or behavioral problems received mental health care in Illinois3.
Sources:  1. Behavioral Risk Factor Surveillance System , ; 2. Illinois Mental Health Services, Five Year Strategic Plan, 2013; Healthy Chicago 2.0, October 2015; 3. Child and Adolescent Health Measurement Initiative. 2011 National Survey of Children's Health

10. Cook county data
Roughly 23% of detainees in the Cook County jail present with mental illness1.
In 2015 there were 603 deaths related to opiates in Cook County, and 413 related to heroin2.
Sources: 1. Data from May 2015 – April 2016 presented at special Meeting of the CCHHS Board of Directors on May 23, 2016; 2. Cook County Medical Examiner’s Office

11. Cook County Health and Hospitals System
14% of emergency room visits and 16% of inpatient visits at Stroger Hospital are attributed to the growing problems of addiction
Source: Illinois Hospital Association

12. CCHHS Initiatives to Respond to Behavioral Health Needs

13. CCHHS Strategic plan focus areas
Deliver High Quality Care
Grow to Serve and Compete
Foster Fiscal Stewardship
Invest in Resources
Leverage Valuable Assets
Impact Social Determinants of Health

14. CCHHS Behavioral Health Strategies
Improving & Streamlining Access
Addressing the Opioid Crisis
Innovations & Partnerships

15. Timeline of Cchhs behavioral health initiatives
Behavioral Health Consortium
Convened in April 2016
Justice and Mental Health Collaborative convened in July 2016
Assisted Outpatient Treatment (AOT)
Oct 2016
Vivitrol at Cermak Health Services
May 2017
West Side Community Triage Center
TBD
Housing solutions for justice-involved
TBD
Behavioral Health Integration at PCMHs
January 2016
Expanded services for medication assisted treatment (MAT)
April 2016
Roseland Community Triage Center
Fall 2016
Opioid Taskforce
March 2017
Pilot BH Screening & Case Management at Bond Court
June 2017

16. Improving & Streamlining access
Integration of behavioral health services into Patient Centered Medical Homes
Creation and support of behavioral health consortium

17. Addressing the opioid crisis
Expanded Medication Assisted Treatment (MAT)
Buprenorphine waiver trainings for MDs/NPs/PAs
Naloxone training and distribution for ED, pharmacists, correctional health staff
Vivitrol pilot at the Cook County Jail
Opioid Taskforce

18. Innovations & Partnerships
Community Triage Center
Justice and Mental Health Collaborative
Assisted Outpatient Treatment
Care Coordination Screening and Services at Cook County Bond Court

19. Lessons Learned

20. Challenges and opportunities
Historically Fragmented Funding Sources and Disinvestments in Community-based Behavioral Health
Our Lack of Knowledge of Other Providers
State Budget Impasse
Federal Budget & Policies
Opportunities
Housing
Illinois 1115 Waiver Application
Broad Support to Address the Opioid Crisis
County Support and Commitment to Implementation of CCHHS Strategic Plan Initiatives

21. Questions?