1. Effective Bi-Directional Integration: Evidence Based & Best Practices Presented by: Kathleen Reynolds LMSW ACSW kathyr@thenationalcouncil.org

2. WHY BI-DIRECTIONAL INTEGRATION?

3. Persons with serious and persistent mental illness die, on average at the age of 53 Higher Rates of Modifiable Risk Factors: Smoking Alcohol consumption Poor nutrition / obesity Lack of exercise Unsafe sexual behavior IV drug use Residence in group care facilities and homeless shelters Vulnerability due to higher rates of: Homelessness Victimization / trauma Unemployment Poverty Incarceration Social isolation

6. Model of Bi-Directional Integration

8. Models – Bi-Directional Integration Behavioral Health –Disease Specific IMPACT RWJ MacArthur Foundation Diamond Project Hogg Foundation for Mental Health Primary Behavioral Healthcare Integration Grantees Behavioral Health - Systemic Approaches Cherokee Health System Washtenaw Community Health Organization American Association of Pediatrics - Toolkit Collaborative Health Care Association Health Navigator Training Physical Health TEAMcare Diabetes (American Diabetes Assoc) Heart Disease Integrated Behavioral Health Project – California – FQHCs Integration Maine Health Access Foundation – FQHC/CMHC Partnerships Virginia Healthcare Foundation – Pharmacy Management PCARE – Care Management Consumer Involvement HARP – Stanford Health and Wellness Screening – New Jersey (Peggy Swarbrick) Peer Support (Larry Fricks)

9. What do we know about what works? Three strategies have been identified in a meta-analysis of successful integration programs A consulting psychiatrist A primary care provider prescribing all meds Care coordination (Gilbody, 2006)

10. Additional Implementation Strategies for Bi-directional Integration Partnerships between behavioral health and primary care or do it yourself Financing: Maximize existing billing options to fund integrated care Staffing: PhD, LMSW, LPC, BSW, Consumers Electronic Medical Records Registries Bridging the professional culture gap