1. Evaluating Integrated Behavioral Health:
A Tale of 8 Cities

2. 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

3. This Project is funded by:

4. What is ?

5. 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).

6. 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:

7. What is Integrated Care?

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

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

11. Current Levels of Integration

12. Future Levels of Integration

13. 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

16. 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

17. 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

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

23. 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.

26. 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

27. 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

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

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

30. 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

33. 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).

34. Reverse Co-Location Integrated Behavioral Health (IBH) Model

37. 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

40. Questions & Discussion