1. Partnerships for Successful Integration of Behavioral Health and Primary Care Maribel Cifuentes, RN, BSN, Deputy Director, Advancing Care Together Larry Green, MD, Director, Advancing Care Together Shandra Brown Levey, PhD, Primary Care Psychologist Linda Niebauer, Director of Communications, Advancing Care Together University of Colorado, Department of Family Medicine Collaborative Family Healthcare Association 15 th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A. Session # G2a Friday, October 11, 2013

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

3. Objectives 1.List key questions you and your partner should answer before “getting married.” 2.Identify key words and terms that you should define and agree on to describe your joint integration work. 3.Choose one or two strategies you can apply in your setting to improve the likelihood of success in your partnership.

4. Learning Assessment Audience Question & Answer will take place at the end of the presentation. Audience interaction is encouraged throughout the presentation.

5. Advancing Care Together 5-year program of The Colorado Health Foundation 11 innovation sites Rural, urban, suburban CO Primary care practices and community mental health centers Diverse innovative strategies to better integrate BH and primary care services to meet the needs of patients and communities United as a learning community and by a multi-method learning evaluation

6. 1.Miramont Family Medicine (Ft. Collins) 2.Westminster Medical Clinic (Westminster) 3.Salud Family Health Centers (Brighton) 4.Jefferson Center for Mental Health (Wheat Ridge) 5.Denver Health, Lowry Clinc (Denver) 6.Kaiser Permanente, Skyline (Denver) 7.Midvalley Family Medine (Basalt) 8.Primary Care Partners (Grand Junction) 9.CU Aging Center (Colorado Springs) 10.Southeast Mental Health Services (La Junta) 11.Axis Health System, Cortez Clinic (Cortez) ACT Innovators

7. Duck billed platypus

8. Peek 7: Questions that Need Answers 1.Why are you integrating primary care into your community mental health center, or behavioral health into your primary care practice? 2.What is your vision for integrated care? 3.What should you find out about your patient population to make integrated care most successful? 4.How will you make the patient experience of care seamless? 5.What do you need to operationalize your integrated health services? 6.How will you integrate primary care providers / behavioral health professionals into your clinic? 7.What will be demonstrated and measured? How will you measure success?

9. Language Matters

10. 5 Key Words and Definitions 1.Primary care 2.Behavioral health 3.Integrated care 4.Collaboration 5.Leader

11. Primary Care

12. Behavioral Health Term encompassing care for mental health, substance mis-use, health behavior change, life stressors and crises, as well as stress-related physical symptoms.

13. Integrated Care Care rendered by a practice team of primary care and behavioral health providers, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care. This care may address diverse behavioral health needs. Models of integrated care may vary on numerous levels, including but not limited to characteristics of the care team, spatial arrangements, type of collaboration, and protocols for patient detection, treatment, and follow-up. Common integrated care models include collaborative depression care, primary care behavioral health, and co-located mental health and primary care services.

14. Collaboration Involves joint planning and execution, with two or more partnering entities working together to coordinate at multiple points to carry out a combined effort to accomplish a shared vision.

15. Organizational Relationships Isolation / Mutual Awareness Isolation: Entities working completely separately Mutual Awareness: Agencies are informed about each other and each others’ activities Cooperation Denotes some sharing of resources, such as space, data, or personnel Collaboration Involves joint planning and execution, with both entities working together to coordinate at multiple points to carry out a combined effort Partnership Implies programmatic integration, with two entities working so closely that there is no separation from the end user’s perspective. Effect is nearly seamless Merger / Single Organization Merger: One combined entity replacing the formerly separate entities Single Organization: One organization to start

17. Leader Those who can create the conditions under which desired change can occur. They strongly influence how professional interactions unfold and whether teams are able to innovate, “fail”, and try again. They play a critical role engaging on-the- ground professionals in decisions. When multiple organizations partner, leaders from each setting must inform the integrated care approach. These individuals bridge organizations – frequently facilitating and mediating interpersonal relationships and organizational objectives. They help facilitate new ways of working together and foster camaraderie and culture change. Every member of the integrated care team can be a leader.

18. 2 Partnership Stories Story 1 Story 2 What pitfalls do you think are in store for those in story 1? How about story 2? What are your stories of partnership? What pitfalls and benefits have you experienced?

19. 5 Strategies for Success 1.Share a vision 2.Understand team strengths/weaknesses 3.Protect time and space for coming together 4.Understand costs and revenues 5.Establish outcomes measures

20. Lessons from Geese http://www.youtube.com/watch?v=UdEjL9bVcCM

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