1. Integrated Care in the Real World presented at the NIDA CTN Steering Committee Meeting Washington, D.C., September 21, 2010, 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 To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon

5. Barriers to Integrated Care in the Primary Care Setting Lack of time Lack of skills Beliefs and attitudes about SUD/MH Lack of confidence in SUD/MH treatment HIPAA/42CFR Part 2 Billing, records Sustainability

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

7. Results Screened approximately 2,000 patients/year (20% of total patients per year) Providing treatment to about 15%; 50% of these are 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%*

8. “Frequent flyers” had significantly less (p<.01) medical utilization after BHC sessions for both OPT and ER visits

9. Low utilizers had more visits after BHC contact (not significant)

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