Transcript PPT - Lily Alvarez and Darren Urada

Integrated Learning
Collaborative
Treatment of Substance Use and
Mental Health Disorders in Primary
Care in the Era of Health Reform
February 22, 2012
Integration of Mental Health &
Substance Use Disorders into
Primary Care: Models of CoLocated and Integrated Services
Lily Alvarez
Kern County Mental Health
Darren Urada, PHD
UCLA Integrated Substance Abuse Programs
What Does Our County Look
Like?
• Mental Health System of Care
• Substance Abuse System of Care
• FQHCs
What MHSA Opportunities are
Provided?
• Integration
• Workforce
• Two services in same day
• Address both MH and SUD
• Time
Spoken Goals
• Universal screening
• Brief interventions
• Technology via health registries
Unspoken Goals
• Develop a value for the SAS
• Develop the blood pressure cuff for
SUD
• Close the gap between primary
care and specialty care
• Demonstrate how to overcome
security and privacy issues
• Building capacity for 2014
What is the Model?
• Universal screening
• Brief consultation in the exam
room
• Brief interventions
• Integrated case conferencing
• Using data to monitor progress
Anticipated Barriers and
Proposed Solutions
• Being in the forefront; creating a
learning environment
• Competition; monthly provider
meetings
• Physician involvement; contractual
requirements for case conferencing
• New practice standards; technology
transfer through events
Current Barriers
• Fear of recognizing the SUD
patient
• Filing in the medical record
• Charting in the medical record
Health Information Exchange
• 42 CFR Part 2 requires:
Individual consent
Specificity
Prohibits re-disclosure
• Between primary care and specialty
Diagnosis
Lab results
Medications
UCLA and Evaluation
• Prevalence
• Baseline with the Dual Diagnosis
Capability in Health Care Settings
(DDCHCS) tool
• The pipeline using i2i data
• Perceptions and attitudes
Prevalence Preliminary Results
• Prevalence of depression
• Prevalence of thought disorders
• Prevalence of alcohol and drug
DDCHCS Integration Measure: Baseline
• Completed in 2011
• Follow-up planned in 2012
• A word about the scores…
– “5” is not necessarily the goal
• Although this is a measure of integration, for some
sites it may be impossible or even undesirable to
reach “5” on DDCHCS.
• Not every hospital needs to be a Level-I trauma
center. Not every site needs a 5 on DDCHCS.
• This is a snapshot to allow sites to assess where
they are, whatever the goal is.
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Administrative Data
“Patient Pipeline”
Referred
All
Positive
Assessed
Patients Screened Screen
for
assessment
Positive
Assessment
Referred:
on-site
intervention
15
Rec’d
Intervention
Referred:
off-site
treatment
Rec’d
Treatment
No
Shows
Staff Perceptions & Attitudes
Surveys
Adapted from surveys developed by the Integrated
Behavioral Health Project (http://www.ibhp.org/)
Multiple versions used:
• Behavioral Healthcare Provider Satisfaction Survey
• Primary Care Provider Satisfaction Survey
• Primary Care Provider Satisfaction Survey - Non
PCP Staff
16
Examples of survey questions (out of 23)
1. I am satisfied with the ability of the medical staff at my clinic to address the needs of
patients with mental health disorders, substance use disorders, and/or other psychosocial
issues.
О Agree Strongly
О Agree
О Uncertain
О Disagree
О Disagree Strongly
If you would like to explain your answer, please do so here:
_______________________________________________________________________
_______________________________________________________________________
2. I am effective in addressing the needs of patients with mental health disorders, substance
use disorders, and/or other psychosocial issues.
О Agree Strongly
О Agree
О Uncertain
О Disagree
О Disagree Strongly
If you would like to explain your answer, please do so here:
_______________________________________________________________________
_______________________________________________________________________
3. I am comfortable being the “first-line response” for people with mental health disorders,
substance use disorders, and/or other psychosocial issues.
О Agree Strongly
О Agree
О Uncertain
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О Disagree
О Disagree Strongly
* = Statistically significant difference in ratings between staff types
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Questions / Comments?