1. Integrating Health Care in Appalachian Ohio Family Healthcare Inc. (FHI) A federally qualified health center with the mission to provide access to affordable, high quality health care to everyone without discrimination. Locations in (6) Appalachian counties in southeastern Ohio. Health Recovery Services (HRS) “Where change and recovery begin”. HRS is a behavioral health service provider with both outpatient and residential treatment options for consumers. Locations in (4) Appalachian counties in southeastern Ohio.

2. Aim #1 Establish systematic method of screening patients for substance abuse problems within a primary care setting. Chart audit of Dr. G’s new patients in January 2010 revealed that all were screened per history form 11 – completely negative screening 16 – nicotine only 10 – nicotine and ETOH 2 – nicotine, ETOH, MJ While screenings were being done at baseline level, there was no systematic follow-up or referral. We realized the first step would require education for staff and provider(s).

3. Dr. G researched SBIRT (screening, brief intervention, referral, and treatment) and started doing more in depth screening with patients, which did lead to increased referral to HRS. HRS sponsored a CME about addiction medicine an (8) FHI providers attended to increase knowledge of substance abuse and importance of screening. HRS Director, nursing director, and Clinician presented at FHI Athens staff meeting about HRS available services. Also discussed information needs of all providers.

4. Increased identification of patients with substance abuse problems Increased awareness of staff and providers of Athens office about SBIRT Increased referrals to HRS – this was previously happening, but we are working on a more formalized process with better tracking (still a lot of room for improvement) Found referrals to HRS from FHI increased from (0) per month January to (1) per month June 2010 with many other informal referrals (recommendations)

5. Continue to evaluate and improve screening process Spread more formalized screening to other providers at Athens site Have HRS counselor come on site at FHI to work with staff about developing collaborative screening/referral process Experiment with placement of an HRS clinician at FHI to “test” alternative screening procedures and encourage clients to improve referral follow through

6. AIM 1. Establish a systematic method of screening patients for substance abuse problems within the primary care setting. 2. Increase the number of HRS consumers who receive primary healthcare services 3. Start with Athens County HRS office and Athens County FHI office with (1) provider.

7. AIM #2 Increase number of HRS consumers who receive primary healthcare services

8. Survey was done to see if /where clients were accessing healthcare and HRS clients use the ER quite frequently instead of PCP Nursing personnel at HRS increased medical screening for clients such as blood sugar or blood pressure checks Intensified referral process to help clients make primary care appointments

9. HRS substantially increased referrals to FHI from (6) per year to (4) per month. However many referrals in both directions were “no shows”.

10. Improve tracking of referrals in both directions Make stronger use of HRS case managers to facilitate compliance with referrals to FHI.

11. Lessons Learned *Relationship building is key *Communication cannot be overemphasized *More work is needed on referral follow-up *Education is needed to help people view healthcare holistically. *Substance disorders are chronic illnesses, and should be treated as such in Primary care with a team approach *Integration of healthcare is a lot of work, but well worth it