Making Integrated Care Work

Contact Us: 202.684.7457

SAMHSA-HRSA Center for Integrated Health Solutions

View Menu
Glossary
Facebook Twitter Listserve Ask a Question

e-Solutions February 2015

eSolutions: February 2015

Feature article: The Heart of the Matter
Grantee Spotlight: Supporting Wellness in the Mountain State: Prestera Center
Quick Tips: 6 Ways to Promote Heart Health
Featured resource:  Million Hearts partner toolkits
Hot Topics
Webinars


The Heart of the Matter

By Larry Fricks, Deputy Director, SAMHSA-HRSA Center for Integrated Health Solutions

At the heart of it all. Get to the heart of the matter. The Heartland. The heart is synonymous with the center for many reasons, not least because its health is central to whole health.

Heart disease is the leading cause of death in the United States, and is responsible for 1 of every 4 deaths.[1]  People with serious mental illness (SMI) have an even higher mortality rate from heart disease, and are between 25 to 40 percent more prone to die from heart disease than people without mental illness.[2]This difference is why heart disease is one of the largest contributors to the significant mortality gap between individuals with SMI and the general population.

Why is this the case?

Individuals with SMI have risk factors for heart disease at as much as twice the rate of the general population.[3] This can be due to a number of factors, such as a lack of access to primary care services, poor nutrition, smoking or the side effects from atypical antipsychotic medications. Compared with the general population, enrollees in SAMHSA primary and behavioral health care integration (PBHCI) programs are likelier to have high cholesterol, high blood pressure, high body mass index (BMI) and to smoke – all factors that put them at increased risk for cardiovascular disease.

Individual Risk Indicators: SMI Means Increased Risk

 

 

 

 

 

 

(n=5,261 – 25,894)

It is important to remember that all of these factors are modifiable. An individual can lower the risk for these factors by eating healthy, engaging in regular physical activity, stopping smoking, and drinking moderately (or not at all).

Changing the statistics

Integrated primary and behavioral health care providers can take simple steps to encourage heart healthy behaviors among the people they serve. Adopting new healthy behaviors takes time and support and providers cannot offer these tips in isolation. Change happens when your agency’s mission and practices reflect a commitment to promoting heart health, when all staff are aware of and involved in this direction. Treatment, services, supports and interventions are of little value without individuals setting and achieving person-centered whole health goals.

Incorporating simple heart disease prevention and self-management interventions into standard clinical practice – including regular measuring of these health indicators, ordering and reviewing labs for cholesterol, tracking progress via an electronic health record and adopting an agency-wide culture of wellness – can make a difference.  

Million Hearts® is a national initiative from the US Department of Health and Human Services (HHS) to prevent 1 million heart attacks and strokes by 2017. The foundation of Million Hearts aligns with the principles of integrated care: to use team-based care, to improve access to care, to track and use data on health measures to improve quality, and to activate self-management to adopt whole health behaviors.

What’s working

Providers recognized as “Hypertension Control Champions” by Million Hearts cite incorporating these sustainable changes into their daily practices to improve blood pressure control:

  • tracking patient care over time using EHR prompts and reminders.
  • using team-based care to take advantage of the full skills of every team member to identify and address high blood pressure, provide support and follow-up care, and help patients manage their medicines and follow a blood pressure control plan.
  • reinforcing the importance of adopting heart-healthy behaviors—eating a low sodium diet, getting regular physical activity, maintaining a healthy weight, taking medications as prescribed, and not smoking.

As a result, these champions have seen blood pressure control rates among their at-risk patients increase from 60 to over 90 percent.

Over the past four years, PBHCI grantees have supported enrollees in focusing on these health indicators. Among individuals previously at risk for high blood pressure, nearly 40 percent are no longer at risk, and some grantees report upwards of 70 percent of enrollees with newly-healthy blood pressure.

Get tracking

As of 2012, the Bureau of Primary Health Care within HRSA requires all Federally Qualified Health Centers (FQHCs) to report “ABCS” (Aspirin, Blood Pressure, Cholesterol, Smoking) measures annually into their Uniform Data System to track and improve performance. Integrated care providers can join in measuring and tracking this information as well, such as the percentage of people with high blood pressure who achieve control (typically defined as less than 140/90 mm Hg) or how many people who smoke receive counseling on cessation. Learn more about tracking these measures.

Include peers

Integrated health providers should include certified peer specialists on their team to support activation of whole health self-management. Peer specialists can run wellness programs or facilitate groups such as Whole Health Action Management (WHAM) that take a strengths-based approach to setting whole health goals.  Through Million Hearts, SAMHSA awarded grants to 12 peer-run recovery organizations, including Atlanta-based Another Chance, to increase awareness, reduce risk, and improve management of cardiovascular disease in people with behavioral health conditions. As a result, Another Chance developed and implemented a “90-Day Healthy Heart” pledge and awareness campaign for people in recovery who have heart disease and no primary care physician.

A Matter of the Heart

Integrated care and the Million Hearts initiative are showing that providers can take sustainable, simple steps to making a measurable impact on reducing the preventable deaths by heart disease of people with mental illness. Each implementation step may seem simple, but making change really requires taking these actions to heart – making sure they are central to your agency’s mission and practices.

Learn more about Million Hearts initiative on their website, including information about how you can help prevent heart disease and educational materials (including healthy recipes and infographics) for individuals and families. 

[1] http://millionhearts.hhs.gov/aboutmh/overview.html

[2] Kilbourne AM, et al. Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors. Gen Hosp Psychiatry 31(6), 2009. 

[3] American Medical Association, 2007

Grantee Spotlight: Supporting Wellness in the Mountain State

West Virginia has the fourth highest mortality rate from cardiovascular disease in the country, and it is the leading cause of death for both men and women in the state.[4] All too often, people with cardiovascular disease suffer from premature morbidity and mortality as a result of poor diet, and lack of exercise and primary prevention services. Fitness and a diet low in saturated fat and cholesterol can be vital to preventing heart disease, stroke, and other cardiovascular conditions.

That’s why the Prestera Center, a SAMHSA Primary and Behavioral Health Integration (PBHCI) grantee that serves more than 50 counties in West Virginia, addresses fitness and nutrition as top priorities to improve the health of people they serve and to combat preventable conditions like cardiovascular disease. 

Wellness coaches are integral to the success of the fitness and nutrition initiatives at the Prestera Center. To promote awareness and education about wellness throughout the center, the coaches teach courses in topics from diabetes management to tobacco cessation and facilitate groups such as wellness recovery action plans (WRAP). All wellness initiatives and activities are highlighted in their monthly newsletters, along with healthy recipes, for staff and clients to stay informed about all the offerings.  The center provides educational material through monthly initiatives, such as tables with heart healthy snacks during American Heart Month, and ongoing through handing out educational resources such as What Your Numbers Mean, which talk about the importance of low blood pressure and low cholesterol. A bulletin board in the lobby also lets clients share their top wellness tips or leave suggestions for further information.

Since regular physical activity and maintaining a healthy weight is essential to decreasing risk for heart disease, wellness coaches and other staff lead fitness initiatives like walking groups, many of which are now client-driven. Throughout Prestera’s many sites, the wellness coach works to institute a quarterly fitness challenge with clients and staff.

Through a partnership with the local YMCA, individuals can work with a nutritionist and exercise physiologist onsite at the YMCA to set attainable goals. A goal summary is then provided back to the wellness coordinator. Soon, individuals will be able to use Prestera’s onsite fitness center. The fitness center will include a treadmill, exercise bike and workout DVDs, as well as safety and educational information. One wellness coach is even working to become a certified personal trainer and will be able to help clients maintain their progress from the YMCA.

Staff at the center encourage participation in wellness programs at intake when clients review a checklist of the center’s ongoing activities, like Whole Health Action Management (WHAM) or a walking group. They are also asked about their last visit to a primary care provider, if a referral is necessary to the onsite primary care clinic and if they would like to see a wellness coach.

The center knows that physical activity and nutrition are key to improving not only heart health, but all health outcomes.  And they know they wouldn’t have been as successful without creative solutions that involve both staff and those they serve.

How does your center promote physical activity and nutrition? Let us know, email Integration@theNationalCouncil.org

[4] American Heart Association, 2010

Quick Tips: 6 Ways to Promote Heart Health

How can you encourage heart healthy activities in your organization? Here are six ways to make wellness ingrained in your agency’s culture.

  • Provide nutrition educational materials and resources in your center’s lobby and other shared spaces, such as heart healthy recipes from Million Hearts and the National Institutes of Health (including culturally appropriate recipes).
  • Serve healthy snacks or meals in onsite cafeterias and at events.
  • Encourage staff to lead walking groups at your organization’s location or at parks in your community.
  • Consider partnerships with local YMCAs or gyms to help promote physical activity.
  • Educate those you serve on the importance of maintaining low blood pressure and low cholesterol. This Million Hearts Action Guide Series focuses on blood pressure control and provides clinicians with evidence-based strategies.
  • Promote tobacco cessation and smoke-free air policies throughout your organization. Check out these resources to find out how to get started.   

What other ways do you support the heart health of your clients? Check out our Wellness Strategies page for more.


Featured Resource

Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes by 2017. The Partner toolkits outline how you can– and how you can encourage other community partners – to join in on the initiative to fight heart disease and stroke.


Hot Topics

SAMHSA announced a new grant opportunity for community-level providers to prevent and reduce the onset of substance abuse and transmission of HIV/AIDS among at-risk populations, including racial/ethnic minority youth and young adults.

The Addiction Technology Transfer Center (ATTC) Network announced a new multi-media package, Marijuana Lit: Fact Based Information to Assist You in Providing SUD Services.  Providers can browse videos, download infographics and access other free online resources to enhance how they address marijuana issues in their work.

SAMHSA is now accepting applications for the National Consumer and Consumer Supporter Technical Assistance Centers grants. The program provides technical assistance to promote consumer-directed approaches for adults with serious mental illnesses.

The Food and Drug Administration (FDA) is advising consumers that blood pressure cuffs on public kiosks are not “one size fits all” and might not provide accurate results for every user.  The guidance notes that cuff size is critical in providing correct blood pressure readings and kiosks should be used to augment care under the guidance of a health care provider.

The California Association of Social Rehabilitation Agencies (CASRA) with support from Integrated Behavioral Health Project and funding from the California Mental Health Services Authority announced a new toolkit, Meaningful Roles for Peer Providers in Integrated Healthcare. The toolkit provides integrated care settings with information on how to best hire, train, integrate and retrain Health-Trained Peer Support Specialists onto multi-disciplinary teams.


Webinars

How Are They Doing It? Best Practices in Sustaining On-Site Training of Behavioral Health Clinicians

Wednesday, March 11, 2:00-3:30 pm EST

As integrated care evolves as a foundation for health care design, quality and value, we must remain attentive to behavioral health workforce development needs. Join this webinar discussion on training and education from three perspectives – community provider, federal agency and area health education center (AHEC) – on everything from building community relationships for education and training to providing orientation programs for students and trainees and matching trainees with field sites. Join this webinar to learn how these programs develop protocols for how to effectively provide field placements, including accounting for mentor time, effectively dealing with the business costs of intern positions for health care provider organizations (field placements), and addressing the need to provide services while training interns. Register here.

Bridging the Divide: Improving Transitions of Care to Reduce Hospital Readmissions

Thursday, March 19, 2:00-3:30 ET

Do you have certain clients who seem to be in and out of the hospital? As a behavioral health provider (either in a primary or behavioral health care organization), is it difficult for you to keep track of treatment plans for clients who see different providers (e.g., receiving inpatient care or at the emergency department)? Join this webinar to review promising care transition models, initiatives and payment incentives that can be employed to promote collaboration between inpatient and outpatient providers; hear how one community provider implemented a successful care transition program; discuss strategies to increase success of discharge and treatment planning; and get tips on how to encourage individuals and family members to manage their care.  Register here.

Have a topic you’d like CIHS to explore on a future webinar? Let us know, email Integration@TheNationalCouncil.org.

Call Our Helpline: 202.684.7457

eSolutions: February 2015

Feature article: The Heart of the Matter
Grantee Spotlight: Supporting Wellness in the Mountain State: Prestera Center
Quick Tips: 6 Ways to Promote Heart Health
Featured resource:  Million Hearts partner toolkits
Hot Topics
Webinars


The Heart of the Matter

By Larry Fricks, Deputy Director, SAMHSA-HRSA Center for Integrated Health Solutions

At the heart of it all. Get to the heart of the matter. The Heartland. The heart is synonymous with the center for many reasons, not least because its health is central to whole health.

Heart disease is the leading cause of death in the United States, and is responsible for 1 of every 4 deaths.[1]  People with serious mental illness (SMI) have an even higher mortality rate from heart disease, and are between 25 to 40 percent more prone to die from heart disease than people without mental illness.[2]This difference is why heart disease is one of the largest contributors to the significant mortality gap between individuals with SMI and the general population.

Why is this the case?

Individuals with SMI have risk factors for heart disease at as much as twice the rate of the general population.[3] This can be due to a number of factors, such as a lack of access to primary care services, poor nutrition, smoking or the side effects from atypical antipsychotic medications. Compared with the general population, enrollees in SAMHSA primary and behavioral health care integration (PBHCI) programs are likelier to have high cholesterol, high blood pressure, high body mass index (BMI) and to smoke – all factors that put them at increased risk for cardiovascular disease.

Individual Risk Indicators: SMI Means Increased Risk

 

 

 

 

 

 

(n=5,261 – 25,894)

It is important to remember that all of these factors are modifiable. An individual can lower the risk for these factors by eating healthy, engaging in regular physical activity, stopping smoking, and drinking moderately (or not at all).

Changing the statistics

Integrated primary and behavioral health care providers can take simple steps to encourage heart healthy behaviors among the people they serve. Adopting new healthy behaviors takes time and support and providers cannot offer these tips in isolation. Change happens when your agency’s mission and practices reflect a commitment to promoting heart health, when all staff are aware of and involved in this direction. Treatment, services, supports and interventions are of little value without individuals setting and achieving person-centered whole health goals.

Incorporating simple heart disease prevention and self-management interventions into standard clinical practice – including regular measuring of these health indicators, ordering and reviewing labs for cholesterol, tracking progress via an electronic health record and adopting an agency-wide culture of wellness – can make a difference.  

Million Hearts® is a national initiative from the US Department of Health and Human Services (HHS) to prevent 1 million heart attacks and strokes by 2017. The foundation of Million Hearts aligns with the principles of integrated care: to use team-based care, to improve access to care, to track and use data on health measures to improve quality, and to activate self-management to adopt whole health behaviors.

What’s working

Providers recognized as “Hypertension Control Champions” by Million Hearts cite incorporating these sustainable changes into their daily practices to improve blood pressure control:

  • tracking patient care over time using EHR prompts and reminders.
  • using team-based care to take advantage of the full skills of every team member to identify and address high blood pressure, provide support and follow-up care, and help patients manage their medicines and follow a blood pressure control plan.
  • reinforcing the importance of adopting heart-healthy behaviors—eating a low sodium diet, getting regular physical activity, maintaining a healthy weight, taking medications as prescribed, and not smoking.

As a result, these champions have seen blood pressure control rates among their at-risk patients increase from 60 to over 90 percent.

Over the past four years, PBHCI grantees have supported enrollees in focusing on these health indicators. Among individuals previously at risk for high blood pressure, nearly 40 percent are no longer at risk, and some grantees report upwards of 70 percent of enrollees with newly-healthy blood pressure.

Get tracking

As of 2012, the Bureau of Primary Health Care within HRSA requires all Federally Qualified Health Centers (FQHCs) to report “ABCS” (Aspirin, Blood Pressure, Cholesterol, Smoking) measures annually into their Uniform Data System to track and improve performance. Integrated care providers can join in measuring and tracking this information as well, such as the percentage of people with high blood pressure who achieve control (typically defined as less than 140/90 mm Hg) or how many people who smoke receive counseling on cessation. Learn more about tracking these measures.

Include peers

Integrated health providers should include certified peer specialists on their team to support activation of whole health self-management. Peer specialists can run wellness programs or facilitate groups such as Whole Health Action Management (WHAM) that take a strengths-based approach to setting whole health goals.  Through Million Hearts, SAMHSA awarded grants to 12 peer-run recovery organizations, including Atlanta-based Another Chance, to increase awareness, reduce risk, and improve management of cardiovascular disease in people with behavioral health conditions. As a result, Another Chance developed and implemented a “90-Day Healthy Heart” pledge and awareness campaign for people in recovery who have heart disease and no primary care physician.

A Matter of the Heart

Integrated care and the Million Hearts initiative are showing that providers can take sustainable, simple steps to making a measurable impact on reducing the preventable deaths by heart disease of people with mental illness. Each implementation step may seem simple, but making change really requires taking these actions to heart – making sure they are central to your agency’s mission and practices.

Learn more about Million Hearts initiative on their website, including information about how you can help prevent heart disease and educational materials (including healthy recipes and infographics) for individuals and families. 

[1] http://millionhearts.hhs.gov/aboutmh/overview.html

[2] Kilbourne AM, et al. Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors. Gen Hosp Psychiatry 31(6), 2009. 

[3] American Medical Association, 2007

Grantee Spotlight: Supporting Wellness in the Mountain State

West Virginia has the fourth highest mortality rate from cardiovascular disease in the country, and it is the leading cause of death for both men and women in the state.[4] All too often, people with cardiovascular disease suffer from premature morbidity and mortality as a result of poor diet, and lack of exercise and primary prevention services. Fitness and a diet low in saturated fat and cholesterol can be vital to preventing heart disease, stroke, and other cardiovascular conditions.

That’s why the Prestera Center, a SAMHSA Primary and Behavioral Health Integration (PBHCI) grantee that serves more than 50 counties in West Virginia, addresses fitness and nutrition as top priorities to improve the health of people they serve and to combat preventable conditions like cardiovascular disease. 

Wellness coaches are integral to the success of the fitness and nutrition initiatives at the Prestera Center. To promote awareness and education about wellness throughout the center, the coaches teach courses in topics from diabetes management to tobacco cessation and facilitate groups such as wellness recovery action plans (WRAP). All wellness initiatives and activities are highlighted in their monthly newsletters, along with healthy recipes, for staff and clients to stay informed about all the offerings.  The center provides educational material through monthly initiatives, such as tables with heart healthy snacks during American Heart Month, and ongoing through handing out educational resources such as What Your Numbers Mean, which talk about the importance of low blood pressure and low cholesterol. A bulletin board in the lobby also lets clients share their top wellness tips or leave suggestions for further information.

Since regular physical activity and maintaining a healthy weight is essential to decreasing risk for heart disease, wellness coaches and other staff lead fitness initiatives like walking groups, many of which are now client-driven. Throughout Prestera’s many sites, the wellness coach works to institute a quarterly fitness challenge with clients and staff.

Through a partnership with the local YMCA, individuals can work with a nutritionist and exercise physiologist onsite at the YMCA to set attainable goals. A goal summary is then provided back to the wellness coordinator. Soon, individuals will be able to use Prestera’s onsite fitness center. The fitness center will include a treadmill, exercise bike and workout DVDs, as well as safety and educational information. One wellness coach is even working to become a certified personal trainer and will be able to help clients maintain their progress from the YMCA.

Staff at the center encourage participation in wellness programs at intake when clients review a checklist of the center’s ongoing activities, like Whole Health Action Management (WHAM) or a walking group. They are also asked about their last visit to a primary care provider, if a referral is necessary to the onsite primary care clinic and if they would like to see a wellness coach.

The center knows that physical activity and nutrition are key to improving not only heart health, but all health outcomes.  And they know they wouldn’t have been as successful without creative solutions that involve both staff and those they serve.

How does your center promote physical activity and nutrition? Let us know, email Integration@theNationalCouncil.org

[4] American Heart Association, 2010

Quick Tips: 6 Ways to Promote Heart Health

How can you encourage heart healthy activities in your organization? Here are six ways to make wellness ingrained in your agency’s culture.

  • Provide nutrition educational materials and resources in your center’s lobby and other shared spaces, such as heart healthy recipes from Million Hearts and the National Institutes of Health (including culturally appropriate recipes).
  • Serve healthy snacks or meals in onsite cafeterias and at events.
  • Encourage staff to lead walking groups at your organization’s location or at parks in your community.
  • Consider partnerships with local YMCAs or gyms to help promote physical activity.
  • Educate those you serve on the importance of maintaining low blood pressure and low cholesterol. This Million Hearts Action Guide Series focuses on blood pressure control and provides clinicians with evidence-based strategies.
  • Promote tobacco cessation and smoke-free air policies throughout your organization. Check out these resources to find out how to get started.   

What other ways do you support the heart health of your clients? Check out our Wellness Strategies page for more.


Featured Resource

Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes by 2017. The Partner toolkits outline how you can– and how you can encourage other community partners – to join in on the initiative to fight heart disease and stroke.


Hot Topics

SAMHSA announced a new grant opportunity for community-level providers to prevent and reduce the onset of substance abuse and transmission of HIV/AIDS among at-risk populations, including racial/ethnic minority youth and young adults.

The Addiction Technology Transfer Center (ATTC) Network announced a new multi-media package, Marijuana Lit: Fact Based Information to Assist You in Providing SUD Services.  Providers can browse videos, download infographics and access other free online resources to enhance how they address marijuana issues in their work.

SAMHSA is now accepting applications for the National Consumer and Consumer Supporter Technical Assistance Centers grants. The program provides technical assistance to promote consumer-directed approaches for adults with serious mental illnesses.

The Food and Drug Administration (FDA) is advising consumers that blood pressure cuffs on public kiosks are not “one size fits all” and might not provide accurate results for every user.  The guidance notes that cuff size is critical in providing correct blood pressure readings and kiosks should be used to augment care under the guidance of a health care provider.

The California Association of Social Rehabilitation Agencies (CASRA) with support from Integrated Behavioral Health Project and funding from the California Mental Health Services Authority announced a new toolkit, Meaningful Roles for Peer Providers in Integrated Healthcare. The toolkit provides integrated care settings with information on how to best hire, train, integrate and retrain Health-Trained Peer Support Specialists onto multi-disciplinary teams.


Webinars

How Are They Doing It? Best Practices in Sustaining On-Site Training of Behavioral Health Clinicians

Wednesday, March 11, 2:00-3:30 pm EST

As integrated care evolves as a foundation for health care design, quality and value, we must remain attentive to behavioral health workforce development needs. Join this webinar discussion on training and education from three perspectives – community provider, federal agency and area health education center (AHEC) – on everything from building community relationships for education and training to providing orientation programs for students and trainees and matching trainees with field sites. Join this webinar to learn how these programs develop protocols for how to effectively provide field placements, including accounting for mentor time, effectively dealing with the business costs of intern positions for health care provider organizations (field placements), and addressing the need to provide services while training interns. Register here.

Bridging the Divide: Improving Transitions of Care to Reduce Hospital Readmissions

Thursday, March 19, 2:00-3:30 ET

Do you have certain clients who seem to be in and out of the hospital? As a behavioral health provider (either in a primary or behavioral health care organization), is it difficult for you to keep track of treatment plans for clients who see different providers (e.g., receiving inpatient care or at the emergency department)? Join this webinar to review promising care transition models, initiatives and payment incentives that can be employed to promote collaboration between inpatient and outpatient providers; hear how one community provider implemented a successful care transition program; discuss strategies to increase success of discharge and treatment planning; and get tips on how to encourage individuals and family members to manage their care.  Register here.

Have a topic you’d like CIHS to explore on a future webinar? Let us know, email Integration@TheNationalCouncil.org.

© 2011 NCBH, all rights reserved.
1400 K Street NW | Suite 400
Washington, D.C. 20005

Email: integration@thenationalcouncil.org

Phone: 202-684-7457