Map It: eSolutions, June 2011
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
Jeff Capobianco, Performance Improvement Consultant, Health Integration and Wellness Promotion, National Council for Community Behavioral Healthcare
The integration of primary care and behavioral health in the era of healthcare reform will not be easily achieved unless proper attention is paid to choosing and monitoring relevant system-, clinic-, and patient-level measurements. If an organization is not able to describe where it is going and how far it has come in its integration journey, then it is adrift. So what is an organization to do?
One option is to review the literature on integration, which reveals a wide variety of integration measures from which to choose. Often, however, the measures seem more meaningful to the research that was conducted than to the day-to-day work of integration. Another option is to look at the measures specific to integration that funders and credentialing bodies are beginning to require, but too often, those measures seem to lack the relevance most organizations are looking for to track their progress.
There was a time in behavioral health when reporting the cost of services to funders and pulling a sample of patient charts for review by a credentialing agency was enough measurement to qualify an organization for being on course. Until recently, behavioral health organizations measured fee-for-service and individual patient safety, choice, and recovery. Today, healthcare integration in the context of healthcare reform also requires measurement focused on funding bundled care, linking and coordinating care, and population health. Organizations, like people, do not change behavior until the mental models—the thinking—that drive the behaviors change. The mental models do not change until staff are interested in thinking and acting differently. Measures will only be meaningful and relevant when employees can see how the data captured tells the story of their work. So again, what is an organization to do?
The answer is to map it before you measure it. Spending the time to map processes related to clinic patient care and staff workflows is one of the best ways to shift mental models and, therefore, behavior. A natural outcome of process mapping is the identification of measures that tell the story. Until now, process care and workflows have been measured on the basis of how things used to be done (i.e., fee-for-service and chart reviews). Health integration requires different measures, many of which can be found in the literature and from funding and accrediting agencies. Mapping patient care flows and staff workflows is a powerful way to engage staff in doing the new work of integration while uncovering the relevance and meaning of these measures.
In the next eSolutions newsletter, we’ll discuss how to map processes.
- Measuring Health Indicators provides an overview of health indicators being collected by SAMHSA PBHCI grantees.
- Monitoring Worksheet for Patients on Second-Generation Antipsychotics is a useful tool for use in the clinical setting.
- Behavioral Health Screening Tools for Primary Care: Patient Health Questionnaire (PHQ-9), Kessler 6, AUDIT
For more information visit the CIHS website at www.CenterforIntegratedHealthSolutions.org.
CIHS provides training and technical assistance to the Substance Abuse and Mental Health Services Administration’s Primary and Behavioral Health Care Integration grantees. Each issue of eSolutions profiles a grantee’s work.
Central Oklahoma Community Mental Health Center Wellness Center
COCMHC received a Governor’s Commendation at Quality Oklahoma Team Day for its work to reduce health disparities through its Wellness Center.
A person with a mental health diagnosis is five times more likely than a person without such a diagnosis to experience a co-occurring medical condition and less likely to receive medical treatment. To address this problem, COCMHC opened its Wellness Center on Feb 1, 2010, with a SAMHSA grant.
The Wellness Center offers primary healthcare services, including acute care and chronic illness management as well as smoking cessation, flu shots, and health education. It also offers wellness activities such as yoga, walking, and Wii activities. The center provides dental services through a contract. In addition, it leads a medication donation program in which medications that are no longer needed by the original patients are donated from nursing home facilities to COCMHC for use by people who cannot afford to buy medications.
Although the long-term goal of the Wellness Center is to increase the life expectancy of people served at COCMHC, initial outcomes are measured in terms of access to services. To that end, COCMHC has seen an increase in physical health, as measured by CAR scores, for nearly 44% of adults participating in its services. The Wellness Center has provided primary care services to more than 350 people. To date, approximately 400 people have participated in wellness education activities, more than 65 people have received dental services, and 147 people have received flu shots.
Hundreds of conversations about behavioral healthcare are happening on social media sites such as Facebook and Twitter. Are you participating in or even leading these conversations? Social media presents an opportunity for healthcare professionals to engage with peers, industry leaders, and consumers. But to make social media work for you, it’s best to keep in few things in mind:
- Be Useful. Offer resources, links, good content, and information that’s useful. Simply promoting your own events, products, or needs will quickly fall on deaf ears.
- Support Others. If your friend were to send an article that was helpful, you would thank him or her for it. Doing the same on social media builds friendships and creates the networks that make social media hum.
- Don’t spam. Etiquette exists in social media the same way it does in everyday life, and the point of etiquette is to be considerate. Leave comments on Facebook, Twitter, or blogs because they are thoughtful and part of the conversation—not for a personal plug.
- SAMHSA’s Social Media Hub. To assist the public health community in developing and adopting best practices in the use of social media, SAMHSA has established the Social Health Hub. This effort is grounded in the belief that peer learning and peer sharing are fundamental to the long-term success of using online communications for public engagement.
- Recovery Month #RecoveryChat Recap. On Thursday, June 2, Recovery Month hosted its first #RecoveryChat on Twitter focusing on the topic of prevention and early intervention.
Finally, follow some powerful thought leaders on Twitter:
- @HealthIsSocial: Exploring how emerging technologies are changing healthcare and empowering people.
- @DocForeman: Licensed psychologist serving rural communities.
- @SeeChange_mark: Reducing the stigma of mental health problems.
- @APAHelpCenter: Tips and talk about mind–body health from the American Psychological Association.
As you hear their snippets of wisdom, you may find yourself joining the conversation and becoming a thought leader yourself!
Brief Behavioral Health Interventions in Primary Care
September 14, 2011
Hosted by the National Association for Community Health Centers, a CIHS subcontractor
Presenters: Dr. Parinda Khatri, Dr. Ken Mays
Watch our website at CenterforIntegratedHealthSolutions.org for details and registration.
Check out recordings and presentations of the following recent webinars you may have missed:
Introduction to Effective Behavioral Health Service Delivery in Primary Care Settings
June 1, 2011
Hosted by the National Association for Community Health Centers, a CIHS subcontractor
Presenters: Dr. Alexander Blount, Dr. Miguel Olmedo
Looking for clarification on the differences between co-located behavioral health services and truly integrated care? This webinar provided an introduction for clinicians in Federally Qualified Health Centers and Community Behavioral Health Organizations interested in evidence-based practices for integrating behavioral health into primary care. Participants gained valuable information to support their clinical practice, including how behavioral health needs present in primary care, screening and diagnostic practices, clinical routines of integrated care, and team-oriented training.
Person-Centered Health Homes
May 16, 2011
Presenters: Chuck Ingoglia, Larry Fricks
This webinar provided an overview of the history and components of the person-centered health home model, which emphasizes person-centeredness, whole health, and inclusion. Presenters Chuck Ingoglia and Larry Fricks discussed the core elements of a health home approach and provided examples of implementation. Participants received information on how to integrate person-centered planning into health home design and implementation.
Visit CenterforIntegratedHealthSolutions.org for archived recordings and presentations of past webinars.
National Wellness Week: LIVING WELLNESS
Mark your calendars! The first National Wellness Week will be held as part of SAMHSA’s Recovery Month from September 19–25, 2011. The inaugural theme is “Living Wellness.”
People with mental health and substance use disorders die decades earlier than the general population, mostly as a result of preventable medical conditions. SAMHSA—in partnership with the Food and Drug Administration’s Office of Women’s Health—has created the 10x10 Wellness Campaign to promote wellness and increase life expectancies for people with mental health and substance use problems by 10 years, in 10 years.
Stay tuned for more information about National Wellness Week 2011 in future issues of eSolutions or receive information directly in your inbox by joining the 10x10 Wellness Campaign’s Listserv at www.10x10.samhsa.gov/.
Prevention of Mental Disorders, Substance Abuse, and Problem Behaviors: A Developmental Perspective
In the March 2001 issue of Psychiatric Services, leading prevention experts discuss specific recommendations on parenting, child development, and the prevention of depression for a target audience of practicing psychiatrists and mental health professionals.
Pathways to Integrated Healthcare Strategies for African Americans
The report features consensus statements developed to help improve meaningful access to care to holistic and comprehensive behavioral and primary healthcare for African American individuals and families through the development of strategies that are designed to meet their cultural needs.
Health Information Technology
HIT supports care coordination among providers and is an essential piece of primary and behavioral health integration. Visit the HIT section of the CIHS website to access information and resources on HIT-related topics, including electronic health records and health information exchanges.
CPT Codes that Support Primary and Behavioral Health Integration
The health and behavior CPT codes (known as HBAI codes) support assessment and interventions to address the behavior factors affecting physical health conditions. The American Psychological Association has an online tool for using the HBAI codes for primary and behavioral healthcare providers. Developed by Maine Health, this document provides information on using 96100 Health and Behavior codes in primary care settings.
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Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.centerforintegratedhealthsolutions.org, e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks; Editor, eSolutions: Heather Cobb
The SAMHSA–HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.