1. Integrated Care in the Real World presented at the NIDA CTN CTP Caucus Meeting Washington, D.C., March 15, 2011, by John G. Gardin II, Ph.D. Director of Behavioral Health & Research, ADAPT, Inc. Administrator, SouthRiver Community Health Center Clinical Assistant Professor, Oregon Health Sciences University Medical School This project was funded by HRSA/DHHS Rural Health Outreach Grant #1D04RH06903-01.00

2. ADAPT, Inc. Incorporated in 1971 Serving 3 counties SUD: OPT, Res (adult/adolescent) MH: OPT (adult/adolescent) Gambling Corrections/Drug Court Prevention Primary Care +

3. HRSA RHO Grant May 2006-May 2009 To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon

4. Results Screened approximately 2,000 patients/year (20% of total patients per year) Providing treatment to about 15%; 50% of these were Medicaid patients 30% of Medicaid patients provided 70% of utilization (“frequent flyers”) 64% showed significant improvement (HADS) Overall medical utilization by Medicaid patients decreased by 13% For “frequent flyer” Medicaid patients, decreased medical utilization by 33%

6. Overcoming Barriers Full-time co-location of BHC in clinic Modified SBIrT model Staffed by LCSW Establishment of RHC FQHC-LA FQHC? Adaptation to medical clinic schedule/routine “Open” cases; brief sessions; available; M&G Behavioral Medicine billing codes (96150-96155) Use of EBPs

7. What is Working Medical Assistants Overbooking - 50% no show rate Increased appropriate use of psychotropics 15-20 minutes session/brief therapy Use of Behavioral Medicine Codes

8. Continuing Challenges Training issues with CMAs Training issues with providers Schedule challenges Same-day appointments Poor penetration of SUD involved patients eMR and confidentiality

10. Dr. John Gardin (541) 672-2691 drjohngardin2@mac.com drjohngardin2@mac.com