1. Asian Primary Care Integration Asian Community Mental Health Services in partnership with Asian Health Services Cohort 3 Learning Community Region 1 310 8 th Street, Suite 201 Oakland, CA 94607 (510) 451-6729 www.acmhs.org

2. About Our Program Population: Underserved Asian and Pacific Islander (API) adults with serious mental illness New immigrants and refugees with limited English proficiency Located in Oakland, an urban, inner-city setting and primarily serve Alameda County residents Services in nine languages: Cambodian, Cantonese, English, Japanese, Korean, Mandarin, Mien, Tagalog, and Vietnamese Integration Model: Asian Community Mental Health partnered with Asian Health Services, an FQHC Comprehensive integrated care in a co-located facility Strategies to incorporate primary care: To meet the needs of monolingual API clients: Mental health clinicians provide extensive brokerage services including translation, interpretation, warm hand-off to PCP and follow-up Primary care team incorporates culturally appropriate health concepts (chi, balance, etc) in patient care

3. “ACT (Asians Coming Together) for Health” Wellness Classes and Activities: Wellness & Recovery Action Plan (WRAP) Group Exercise/ Walking Group Healthy Living Group Nutrition Classes Chair Yoga/ Pain Management Class Tai Chi Class Art Group Peer Involvement: New Consumer Advisory Board with members from each major cultural/language group to give input and serve as “community liaisons” One of our PBHCI Team members has lived experience as a consumer EHR Vendor: Welligent

4. PBHCI Team Jane Yi, PhD, Project Director Joyce Lim, LMFT, Project Coordinator Tim Lukaszewski, MD, Medical Director and Psychiatrist Susan Park, Clinical Services Manager Tammy Chen, MD, Primary Care Provider Le Thai, NP, Primary Care Provider and Nurse Care Manager Jing Liu, RD, Nutritionist Kristin Johnson, Wellness Coordinator Khoa Dang, Enrollment Specialist Huali Ye, Health Navigator Ruby Chan, Patient Service Rep Team of 15 Multilingual Mental Health Clinicians Anne Saw, PhD, UC Davis Asian American Center on Disparities Research, Program Evaluator

5. Enrollment & Reassessment Successful Strategies: Designated Enrollment Specialist Incentives for mental health clinicians to increase client enrollment and reassessment Outreach through Health and Wellness Events Enrollment through “ACT for Health” Wellness Program Multilingual Mental Health Clinicians complete NOMs reassessment Results: Steady increase in enrollment 95% NOMs reassessment completion rates

6. Health Information Technology Successful Strategies: Hire Consultants Software Procurement Project Implementation Conduct thorough Vendor Evaluation Process, including Demos Obtain Executive Sponsorship Participate in HIT Webinars and Conferences Develop and Implement Communication Plan Develop Project Plan with Milestones HIT Steering Committee Extensive Utilization of TA Join Regional Extension Center CalHIPSO Results: Leadership Commitment & Staff Buy-in for successful EHR implementation Selected appropriate vendor that meets agency needs & grant requirements Anticipated Go-Live Date of early September

7. Successful Community Partnerships Partners Collaborative Activities Outcomes PBHCI Bay Area Collaborative Meet quarterly with 5 other local grantees and participate in joint trainings Share integration and sustainability resources Cost-effective training and technical assistance Oakland Asian Cultural Center & Lincoln Recreation Center Host wellness activities and health fair events Community integration of wellness practices UC Davis Bilingual Student Volunteers Provide translation and interpretation Increased service capacity for monolingual clients Health Care Providers: Medical Insurance Enrollment, Dental, Chiropractic, Nutrition Provide health screenings and information at health fair events Increased health awareness and access to resources

8. Plans for the Future Successfully implement EHR system with a Go-Live Date of early September Meet Stage 1 Meaningful Use Criteria by Sept 30 th Increase enrollment & participation in “ACT for Health” Wellness Program Continue to develop culturally sensitive health and wellness services, such as acupuncture and acupressure Utilize data to drive clinical practice and treatment interventions to achieve better health outcomes Increase peer/family member involvement and consumer-led wellness activities Collaborate with educational institutions (medical, nursing, dental schools and local universities) for workforce development Increase culturally-competent volunteer participation