1. Integrated Behavioral Health Care in a Federally Qualified Health Center (FQHC): Pilot Test of Two Behavioral Health Delivery Models Jennifer DeGroff, PhD Director of Healthcare Development and Integration AspenPointe, Colorado Springs, CO Collaborative Family Healthcare Association 15 th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A. Session #_E3c____ Friday, October 11, 2013

2. Faculty Disclosure I have not had any relevant financial relationships during the past 12 months.

3. Objectives Compare and contrast the Integrated Practice and Co-located Models of integrated physical/behavioral health care in a physical healthcare setting.

4. Peak Vista and A SPEN P OINTE  Established in 1971, became a FQHC in 1976.  We provide medical and dental services to people facing health care access barriers in the Pikes Peak Region.  In 2010, we served 58,922 unduplicated users with 68 providers in over twelve sites.  Established in 1875 as Colorado Springs Relief. Merged with two organizations to form the MHC.  We provide behavioral health and substance abuse services, housing and employment training / work opportunities that that empower the people we serve.  In 2010, we served 21,000 unduplicated users with 120 providers in over 18 sites.

5. A SPEN P OINTE /Peak Vista Story The First Integration Project (2001) Vision: Co-located and partially integrated model Staffing: Therapist only Location: Peak Vista CHC Women’s Health Center Buy-In: Initially present for staff and leadership, but waned over time Project fell apart

6. The Second Integration Project (2006) Drivers that brought us together again: CEO’s had many concerns regarding future of Mental Health and Physical Health Vision: Close Collaboration and Partially Integrated System Location: Peak Vista CHC Family Health Center @ Union Staffing: Started with a therapist and then added in psychiatrist time Buy-In: Clinical and administration, BUT increased commitment to success by leadership Regular corporate and management meetings Clear-the-path attitude This project will not fail!

7. The Current Model Fully Integrated Staffing: 9 licensed BHCs from A SPEN P OINTE Referrals: Directly to the BHC by the primary provider 52,080 BH contact since 2006 2006: 3 staff 2007: 4 staff 2008: 6 staff 2009: 6 staff 2010: 7 staff 2011: 9 staff 2012: 9 Staff

8. ©2006 Kathleen Reynolds (Integrated Care Adaption Only) Adapted from: Doherty, McDaniel and Baird, 1995.

9. Pilot Project: Introduction 10 week pilot program running two behavioral health models within the same clinic: Full Integration and Co-Location We were not aware of any studies running a comparison between models in the same clinic

10. Pilot Project: Method Conducted at the largest clinic with 3 AspenPointe BHCs and 16 medical providers – 2 of the BHCs did “business as usual”, meaning that they continued to do co-visits and follow-ups, with a focus across all behavioral health needs. – One BHC worked as a co-located therapist, meaning that she operated a mini-AspenPointe clinic within Peak Vista and followed all AspenPointe procedures and processes for opening and treating clients. 10 week pilot period (October – December)

11. Pilot Project: Results BHC ModelCo-Located Therapist Model Encounters 468 (between 2 staff) : 69 follow ups, 399 co-visits 57 Unique Clients Served39912 No show RatesN/A 43% for intakes 19% for therapy Productivity 92% (468 encounters, 507 expected based on MOU) 25% (75.25 of 296 available hours was spent with clients) Diagnoses ServedAll Diagnoses, including medical onlyPrimarily PTSD and MDD Outcome MeasureNot able to get data – most clients not seen multiple times 8 of 12 clients had improved scores, thought some were very small improvement (12 to 13.9)

12. Pilot Project: Results Continued Pro’s of Co-Location: – 11 of the 12 patients were uninsured and may not have been able to afford care – More uninterrupted time for each patient. – Many patients who attended the co-located therapy sessions seemed to prefer traditional therapy over the integrated model – Most clients who attended their intake seemed grateful for the opportunity and became engaged in treatment (with two exceptions)

13. Pilot Project: Results Continued Con’s of Co-Location: – Took more time – full opening process to AspenPointe and navigating 2 EHRs – Decreased communication to providers because of 2 EHRs – Wait time to get into co-located BH services – High no show and cancellations rate in the pilot program – Clients (and staff) confusion with two separate organizations

14. Pilot Study: Results Following the pilot, the Peak Vista Medical Providers were asked which model they preferred and they unanimously reported that they preferred the integrated model over co- located. Additionally, the BHC’s unanimously reported that they preferred the integrated model.

15. Conclusions Fully Integrated care model serves significantly more patients than co-located care The productivity of staff is maximized using an integrated approach Provider and BHC satisfaction is high using a fully integrated approach Satisfaction with clients in each model is high

16. Further Research Replicate in other clinics over a longer period of time Use research when establishing practice models to best meet the needs of the clinic and patients

17. Learning Assessment Audience Question & Answer

18. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!