1. Trilogy Behavioral Healthcare Chicago, IL The Evolution of Integrated Healthcare at a Behavioral Health Organization in an Urban Community Sara Gotheridge, MDAlice Geis, DNP, APN Chief Medical OfficerDirector of Integrated Healthcare Mary Colleran, MSW John Mayes, LCSW, CADC Chief Operations Officer President/CEO

2. Agenda Who is Trilogy? Defining the Need The Integrated Healthcare Model Program Outcomes Challenges Lessons Learned Future Directions

3. Who is Trilogy? Trilogy’s mission is to assist people in their recovery from serious mental illness by helping them discover and reclaim their own capabilities and life direction.

4. Who Trilogy Serves 950 clients currently When coming to Trilogy: 48% of clients have co-occurring substance use issues 75% of clients do not have a psychiatrist 40% of clients do not have a primary care physician 18% of clients are homeless Average # of Primary Care encounters annually: 7 Average # of Psychiatry encounters annually: 6 Average # of Medications: 8

5. THE TRILOGY TEAM

6. The Need for Integrated Healthcare Individuals with Serious Mental Illness (SMI) die on average 11-32 years earlier than individuals without SMI, almost always due to highly preventable or manageable medical co-morbidities Stigma Insufficient Access to Primary Care Fragmented Health System Complex psychosocial and biological conditions

7. The Integrated Healthcare Model CULTURE OUTCOMES PEER STAFF PRIMARY HEALTH TECHNOLOGY WELLNESS SERVICES PARTNERSHIPS CONSUMERS LEADERSHIP EDUCATION BEHAVIORAL HEALTH SMOKING CESSATIONSUSTAINABILITY NURSING OCCUPATIONAL THERAPY WORKFORCE

8. Well-coordinated Care Quality Care Person-Centered Shared Mission Creativity Flexibility CULTURE

9. Behavioral Health Primary Care Co-location Layout of site Workforce Care coordination

10. WELLNESS SERVICES Exercise Nutrition Illness Management Self-care Education

11. PARTNERSHIPS Heartland Health Centers Rush University College of Nursing Chicago House

12. SUSTAINABILITY FQHC Billing Utilizing Students Maximizing reimbursement value

13. WORKFORCE DEVELOPMENT Academic Partnership The Center for Integrated Healthcare Education Peer Ambassadors

14. TECHNOLOGY Electronic Medical Records Sharing Information

15. What is a Peer Specialist? Paid staff person who is willing to self-identify as a person with a serious behavioral health disorder with lived experiences. Service Activities: Peer mentoring/coaching Recovery resource connecting Facilitating & Leading Groups Building Community PEER SPECIALISTS

16. Consumer Advisory Council WRAP (Wellness Recovery Action Plan) WHAM (Whole Health Action Management) Trauma-Informed Care CONSUMERS

17. Wellness Fairs Family Nights World AIDS Day Suicide Prevention Week BBQs Landlord Meet & Greet COMMUNITY OUTREACH

18. Practice Apartment OT Assessments: Includes Hygiene, Cooking, Safety, Cleaning & Leisure Activities Adaptive Devices Involvement in Care Team OCCUPATIONAL THERAPY

19. Smoke-Free Campus Participation in the American Cancer Society “Great American Smokeout” Ask about tobacco use at every visit Staff & client groups Staff trained in Ask, Advise, Refer Panelists on SAMHSA Webinar: "Craving Change: Implementing Tobacco Free Policies in Behavioral Healthcare" SMOKING CESSATION

20. LEADERSHIP Frequent communication Administrative & financial investment Technological integration & data management Build trust between partners Focus on mission Buy-in Development Memoranda of Understanding Clear policies, procedures and workflows

21. The Center for Integrated Healthcare Education: Pilot Course: “Integrated Behavioral Health, Primary Care, and Wellness: An Interprofessional Approach.” Mental Health First Aid & Youth Mental Health First Aid Certified Alcohol and Drug Counselor Training EDUCATION

22. MANAGING WITH OUTCOMES Data Collection Monitoring Evaluation Dashboards & Reporting

23. Co-Morbidities and Disparities Biomarker or Disease Our ClientsNationally, individuals with SMI Overall Population BMI (n=486)Obese: 50%60% of patients with bipolar disorder, 70% of patients with schizophrenia, & 55% of patients with depression Obese: 35.7% Diabetes (n=776)15.7%15%-18% of individuals with schizophrenia 11.3% Tobacco Use (n=748)54%75%18.1% Blood Pressure (n=529) Hypertension: 22.5%21.9% of adults identifying with any mental illness experienced high blood pressure Age 18-39: 7.3% 40-59: 32.4% 60+: 65% (Overall: 31.4%)

24. Integrated Healthcare Outcomes Over 1,000 clients have participated in the Trilogy Heartland Integrated Healthcare program over the last four years. Of clients who completed the NOMs (National Outcome Measures) assessments: 47% have an improved BMI (weight management) 44% have an improved HgBA1C (diabetes management) 58% have improved cholesterol 18% have improved blood pressure 36% have improved Breath CO level (smoking cessation)

25. National Outcome Measures Results National Outcome Measures (n=440)Outcome Improved Healthy Overall19% Functioning in Everyday Life62% No Serious Psychological Distress14% Use of Illegal Substances8% Use of Tobacco Products4% Binge Drinking6% Had a Stable Place to Live14% Attending school regularly and/or employed13% Involvement with Criminal Justice System2% Socially Connected47%

26. Consumer Smoking Status 2012 2014 54%46% 38% 62%

27. Challenges Need to continually redesign workflows Need for staff training Stigma Inadequate space Establishing efficient documentation process Integrating technology

28. Addressing Challenges Leadership Learning Community Development of new financial model Increase administrative support Expand role of consumers Increase relevance, accessibility & effectiveness of training Include evaluation in program planning

29. Lessons Learned Need for ongoing staff training Be flexible & patient Focus on qualitative results as well as quantitative Take time to recognize successes Focus on wellness

30. Future Directions Sustainability Enhancing performance measurement and reporting progress of the IHC Identify high risk clients through reporting Population Health Management On-site Pharmacy Services Marketing, and an emphasis on outcome materials Northside Collaborative

31. Questions?