1. Integration in the Field: County Initiatives UCLA Integrated Substance Abuse Programs

2. Educational Objectives Provide background and discuss the importance of behavioral healthcare integration –facilitate understanding the key elements to moving toward integrated care Describe three CA counties’ models of integration –share practical strategies to integrating substance use, mental health, and/or primary care

3. Why is integrated care important? The annual rate of onset of mental health and addictive disorders is about 27%* Research findings consistently suggest that most people who seek behavioral healthcare do so from their primary care providers* Healthcare reform will result in an influx of patients with newly acquired SUD and MH treatment benefits seeking care in PC settings *Strosahl and Robinson (2008)

4. Integration improves patient access to care. –strengthens linkages between medical and behavioral health care –improves continuing coordination of services –improves the identification and linkage of patients to appropriate treatment –blends interventions to treat the whole person rather than isolating a patient’s disorders -Ohl et al. (2008) Why is integrated care important?

5. What is “integrated healthcare”? - the collaboration of mental healthcare (MH), substance use disorder (SUD) treatment, and primary healthcare (PC) service providers to address a patient’s needs holistically and concurrently Coordinated Services Co-located Services Integration of services Integrated Services Minimal Integration Basic Integration at a Distance Basic Integration On-Site Close Partially- Integrated Services Fully Integrated Services

6. Where can integrated care occur? primary care settings community health centers federally qualified health centers emergency rooms/trauma centers prenatal clinics/OB-Gyn offices medical specialty settings for diabetes, liver and kidney disease, transplant programs pediatric clinics college health centers mental healthcare settings substance abuse treatment centers

7. What are the key elements to successful integrated care? Mission Integration – providers across disciplines embracing a common goal Physical Integration – medical and behavioral health providers working in the same immediate area Clinical Integration – seamlessly connecting clinical activities of PC and BH providers -Strosahl and Robinson (2008)

8. Key Integration Elements Cont. Operations Integration – PC and BH providers practicing within a shared infrastructure Information Integration – PC and BH provider sharing clinically relevant information in real time Financial and Resource Integration – financing integrated services using a blended pot of health care and mental health care resources

9. What barriers can we anticipate to successful integration? Differing priorities Differing philosophies Differences in training Different funding streams Documentation and privacy issues

10. Where can I find more information on healthcare integration? The Integration Learning Collaborative Monthly teleconferences on special integration topics County showcases Integration resources and materials provided via e-mail and on the website Please contact Brandy Oeser at btoeser@ucla.edu if you are interested in participating

11. County Models of Integration Riverside County, Karen Kane Merced County, Manuel Jimenez Los Angeles County, Loretta Denering