1. Cooperative Health Center Inc. Helena, Montana Patrick Frawley, LCSW

2. 2 Our Community Lewis & Clark County covers 3,500 square miles 2009 estimated population of 62,000 Average per capita income $19,000 29% below 200% poverty level, and 44% of those are uninsured

3. 3 Our Clinic Opened in 1994 Satellite clinics – Lincoln, MT and God’s Love Shelter Primary Health & Dental Care, Mental Health, Case Management & Medication Assistance Program 6 Medical Providers, 1 Mental Health Provider, 1 Case Manager, 1 Diabetes Educator Typically serve 6000 individuals per year 20,000 encounters per year EMR implemented in May 2009 Telemedicine by end of 2010

4. 4 President’s New Freedom Commission on Mental Health Commission was created in April 2002 Report submitted to President July 2003 www.mentalhealthcommission.gov/reports/reports

5. 5 In a Transformed Mental Health System... Goal 1 – Americans Understand that Mental Health is Essential to Overall Health. Goal 2 – Mental Health Care is Consumer and Family Driven. Goal 3 – Disparities in Mental Health Services are Eliminated. Goal 4 – Early Mental Health Screening, Assessment, & Referral to Services are Common Practice. Goal 5 – Excellent Mental Health Care is Delivered and Research is Accelerated. Goal 6 – Technology is Used to Access Mental Health Care and Information.

6. 6 Goal 4.4: Screen for Mental Disorders in Primary Care, across the lifespan and connect to treatment and supports. This is where we fit in Why was this Important to us? 70% of our patient population carries a mental health and/or chemical dependency diagnosis Very high rate of suicide in our community

7. 7 Our Vision Integrate Mental Health & Chemical Dependency Services into Primary Health Care Received ORHP Grant in 2006 Hired staff, and developed a Community Consortium. The goal of the consortium was to increase patient access to psychiatric & CD services. Boyd Andrew Community Services Center for Mental Health

8. 8 How We Proceeded Fulltime LCSW and Case Manager hired in 2006 LCSW provides brief, focused, cognitive behavioral therapy on site Case Manager provides care coordination, resource & referral services No wrong door – meet and greet Our services are provided on the medical hall Bridge to Boyd Andrew CS & Center for Mental Health

9. 9 Reality vs. Vision The road to hell is paved with good intentions.

10. 10 Our Efforts Met with Limited Success: We inherited a grant that promised the moon and stars Assumed level of support from staff Boyd Andrew & Center for Mental Health had inadequate organizational commitment and service capacities

11. 11 Data – Data – Data The challenge to collect data The challenge to demonstrate progress & outcomes November, 2007 – Patient Tools implemented

12. 12 Some of Our Findings 2007 to present – 1100 screenings Suicide ideation Diagnostic Prevalence and Change (2008/2009) Major Depression31% decrease PTSD16% decrease Bipolar Disorder30% decrease Generalized Anxiety Disorder17% decrease Panic Disorder35% decrease Chemical Dependency65% decrease

13. 13 Outcomes & Lessons Learned Patients pleased with our services One stop shopping Services less stigmatized in medical setting Patients like progress reports Sustainability is complex… lots of support but little funding We almost lost our jobs…

14. 14 Received New ORHP Funding 2009! This allowed us to continue and expand our Mental Health Program We are now targeting CHC patients with co-morbid Diabetes & Mental Health Diagnoses to improve mental health and diabetes control.

15. 15 If you have further questions, please contact us: Patrick Frawley, LCSW Mental Health Coordinator Cooperative Health Center 1930 9 th Ave. Helena, MT 59601 (406)457-8982 pfrawley@co.lewis-clark.mt.us Rebecca Baraby Case Manager Cooperative Health Center 1930 9 th Ave. Helena, MT 59601 (406)457-8983 rbaraby@co.lewis-clark.mt.us