Overview

As the primary care safety-net expands access to behavioral health services, the SAMHSA-HRSA Center for Integrated Health Solutions is organizing practice tools and resources to help implement integrated care. Below we have highlighted a selection of the many resources available to support HRSA supported Safety-Net providers successfully integrate behavioral health. For assistance finding exactly what you’re looking for contact our team at integration@thenationalcouncil.org.

• Behavioral Health Expansion
• Patient-Centered Medical Home
• Integration Models
• Financing & Billing 
  
• Clinical Tools
• Operations Practices & Resources
  
• Health Behavior Change
  
• Workforce Development 
  
• Additional Resources

BEHAVIORAL HEALTH EXPANSION

• Understanding and Implementing UDS Measures for Depression Screening, Documentation, and Practice-Learn, talk and share about the challengesfaced as well as get information to answer questions like:  Who exactly do we need to be screening? What screening tools can I use? What “counts” as a brief intervention?” and “How do I document and record results?”
  -slides
  -recording
  -Follow-up Q&A

• HRSA-16-074 - Bureau of Primary Health Care, Substance Abuse Service Expansion Technical Assistance
  This announcement solicits applications for Fiscal Year (FY) 2016 Substance Abuse Service Expansion. The purpose of this Health Center Program supplemental funding opportunity is to improve and expand the delivery of substance abuse services at existing health centers, with a focus on Medication-assisted Treatment (MAT) in opioid use disorders. 
• HRSA-14-077 Behavioral Health Workforce Education and Training (BHWET) for Professionals
  This announcement solicits applications for the FY 2014 Behavioral Health Workforce Education and Training (BHWET) for Professionals grant program. In support of the White House's Now is the Time initiative, the grant program aims to expand the mental health and substance abuse (jointly referred to as behavioral health throughout the funding opportunity announcement) workforce serving children, adolescents, and transitional-age youth at risk for developing or who have developed a recognized behavioral health disorder.
• HRSA-14-126 Behavioral Health Workforce Education and Training for Paraprofessionals
  This announcement solicits applications for the FY 2014 Behavioral Health Workforce Education and Training (BHWET) for Paraprofessionals grant program. In support of the White House's Now is the Time initiative, the grant program aims to expand the mental health and substance abuse (jointly referred to as behavioral health throughout the funding opportunity announcement) workforce targeting children, adolescents, and transitional-age youth at risk for developing or who have developed a recognized behavioral health disorder.
• Expanding Behavioral Health Services to the Safety-Net (CIHS webinar briefing)
  Behavioral health is essential to health! Mental health service expansion as part of the Affordable Care Act (ACA) provides new opportunities for safety-net providers to integrate mental and substance use care. This webinar briefing focused on specific strategies and resources safety-net providers can take to create fully integrated behavioral health care for the safety-net population. Topics discussed include, best practices including SBIRT; incorporating behavioral health into existing clinical pathways and operations; workforce training; quality improvement; financing for sustainability. 
  - Presentation 
  - Recording
  - Speaker Bios
  - Resources
• Behavioral Health Integration Grantee calls on behavioral health documentation in an integrated setting:
  -June 1, 2015
  -June 3, 2015

PATIENT-CENTERED MEDICAL HOME

• Raising the Bar: Behavioral Health Integration in Patient-Centered Medical Home Standards, reviews the updated patient-centered medical home standards as they relate to behavioral health integration and understand specific ways providers can incorporate behavioral health integration within these standards. During this webinar, patient-centered medical home leads at State primary care associations and HRSA safety-net primary care providers will also have the opportunity to ask questions and engage with NCQA and subject matter experts. 
  
  Presenters:
  - William Tulloch, Director, Government Recognition Initiatives
  - Judith Steinberg, MD, MPH, Deputy Chief Medical Officer, Commonwealth Medicine, University of Massachusetts Medical School
  
  Download the presentation or view the webinar recording.
• Advancing Behavioral Health Integration within NCQA Recognized Patient-Centered Medical Homes reviews the National Committee for Quality Assurance's (NCQA) patient-centered medical home (PCMH) standards and how they relate to the integration of behavioral health into primary care. HRSA-supported safety-net providers who have integrated behavioral health services can use this resource as a guide when preparing to apply to be recognized as a PCMH with NCQA.
• NCQA’s Patient-Centered Medical Home 2014 is an innovative program for improving primary care. The 2014 standards include heightened expectations that recognized practices support patients’ behavioral health, including via collaboration with “behavioral health care providers and [communication of behavioral health care capabilities to patients.”. Access thePPT presentation for an overview of the 2014 standards.
• "Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home." 
  Published in the March, the new document complements the Joint Principles of the Patient-Centered Medical Home (PCMH) and was created to address bringing behavioral health into the PCMH model.
• The Patient-Centered Primary Care Collaborative (PCPCC) is dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home (PCMH). The Behavioral Health Special Interest Group provides networking and educational opportunities, including expert discussions, around the integration of behavioral health within the medical home.
• NACHC Patient Centered Medical Home Institute (PCMHI) aims to build capacity and infrastructure at the state, regional, and national levels to document and improve outcomes in quality, cost, patient and community engagement, and population health. Visit their site to access the PCMHI white paper and other resources. 

INTEGRATION MODELS

• CIHS’ Standard Framework for Levels of Integrated Healthcare is a six-level framework that can be used for planning; creating a common language to discuss integration, progress, and financing; supporting assessment and benchmarking efforts; explaining integration efforts to stakeholders; and clarifying differences in vision between two or more partnering organizations.
• IMPACT (Improving Mood – Providing Access to Collaborative Treatment) modelintegrates depression treatment into primary care and other medical settings and has been shown to be more than twice as effective as traditional depression care. IMPACT also improves physical and social functioning and patients’ quality of life while reducing overall healthcare costs.
• Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.
• The Atlas of Integrated Behavioral Health Care Quality Measures (the IBHC Measures Atlas) was developed for practices and teams that wish to understand if they are providing high-quality integrated behavioral health care or are preparing to implement integrated care.

FINANCING & BILLING

• The Business Case for the Integration of Behavioral Health and Primary Care addresses the business case for integration of behavioral health into primary care and provides guidance on how to evaluate this business case at an individual health center.
• CIHS has developed customized Interim Billing and Financial Worksheets for each state that identify existing billing opportunities for services provided in integrated settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas of potential state policy work.
• Managed care and managed behavioral healthcare play a critical role in the delivery of behavioral healthcare services. Whether Medicaid, Medicare, or commercial insurance, primary care providers need to know how to effectively participate in managed care networks. How to do the Managed Care Dance – What You Need to Know to Participate in Networks shares how to effectively apply and gain acceptance on managed care provider panels.
• Behavioral Health Homes for People with Mental Health & Substance Use Conditions: The Core Clinical Features helps prepares organizations to become health homes by outlining the essential clinical features. 

CLINICAL TOOLS

• As primary care providers integrate behavioral health into their clinical services, universally screening patients for mental health and substance use conditions is often the first step in the process. A variety of screening tools can be used as part of the collaborative care modelfor depression care and SBIRT model to address substance use.
• Brief interventions are evidence-based practices design to motivate individuals at risk of substance abuse and related health problems to change their behavior by helping them understand how their substance use puts them at risk and to reduce or give up their substance use. CIHS offers several brief intervention resources that includes brief screening questions health practitioners can ask during brief intervention.
• CIHS' 3-part webinar series — Helping People Embrace Behavior Change in Healthcare Settings provides primary and behavioral healthcare staff strategies to support individuals’ readiness for health-related behavior change using motivational interviewing.
• Medication assisted treatment (MAT) is the use of pharmacological medications, in combination with counseling and behavioral therapies, to provide a ‘whole patient' approach to the treatment of substance use disorders. Research indicates that a combination of medication and behavioral therapies can successfully treat substance use disorders, and for some people struggling with addiction, MAT can help sustain recovery.

OPERATIONS PRACTICES & RESOURCES

• Partnerships that share providers between organizations allow for expansion to integrated care and the ability to maximize community resources to treat the whole person. CIHS shares tips and resources needed to maintain a healthy primary care-behavioral healthpartnership.
• The Partners in Health Toolkit was developed – partially written and partially compiled – by Barbara Demming Lurie of the Integrated Behavioral Health Project (IBHP) and sponsored by the California Mental Health Services Authority’s (CalMHSA) Statewide Stigma and Discrimination Reduction Initiative. It includes several sections relevant to the patient education model of care.
• AHRQ's Care Coordination Measures Atlas lists existing measures of care coordination, with a focus on ambulatory care, and presents a framework for understanding care coordination measurement. The Atlas is useful for evaluators of projects aimed at improving care coordination and for quality improvement practitioners and researchers studying care coordination.
• As community-based primary and behavioral health care providers come together to better meet patient needs by integrating services and sharing staff, there are practical considerations such as contracting and partnership agreements that will help community health organizations transform from clinical models of integration into truly integrated practices. 

HEALTH BEHAVIOR CHANGE

• The National Institute of Medicine (IOM) report Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities presents concepts that must be embraced by families, policy makers, service systems, and scientists in order to continue to make progress in the area of prevention.
• CIHS' eSolutions article Self-Management Supports: The Ideal for Person-Centered Careprovides quick tips on how to operationalize self-management supports and shares types of tasks (and related resources) to help you ensure self-management support is central to your service delivery.

WORKFORCE DEVELOPMENT

• The CIHS Core Competencies for Integrated Behavioral Health and Primary Careprovide organizations and individual professionals a “gold standard” for the skill set needed to deliver integrated care. They represent the long-term goal of workforce development for professionals with careers in integrated care.
• Integrated care is a team-based model of care, based on the blending of numerous provider disciplines’ expertise to treat a shared population through a collaborative treatment plan with clearly defined outcomes. CIHS' Team Members Page provides resources specific to various professionals including psychiatrists, primary care providers, social workers and more.
• In all disciplines there is supervision provided if required for licensure or practice requirements. However there is added focus on supervision in behavioral health for issues of self –care, clinical assistance, and professional development. As disciplines integrate and work as a single team, supervision models are shifting and having to blend cultures. CIHS has several resources to achieve successful integrated supervision. 

ADDITIONAL RESOURCES

• The Health Resources and Services Administration (HRSA) offers a variety of resources including grant opportunities, data reports and findings, along with awarded grant data, including grantee names, contacts, awarded amounts by fiscal year.
• The National Association of Community Health Centers (NACHC) offers a wide variety of trainings and resources that encompass all facets of health center operations.
• Visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website for additional tools, publications and resources to help reduce the impact of substance abuse and mental illness
• Explore other sections of the CIHS website to discovery additional resources include, tele-behavioral health TTA resources, archives of all CIHS webinars, health information technology tools, and more.