Session # F8 How to Design an Integrated Behavioral Health Care Training and Evaluation Protocol  Period F: Saturday, October 15, 2016 – 10:45 to 11:30 AM Jennifer Hodgson, PhD & Angela Lamson, PhD East Carolina University Francisco Limon, PhD Greene County Health Care Inc. Please insert the assigned session number (track letter, period number), i.e., A2a Please insert the TITLE of your presentation. List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation. You may acknowledge other authors who are not attending the Conference in subsequent slides. CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A. Collaborative Family Healthcare Association 12th Annual Conference

Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months. You must include ONE of the statements above for this session. CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message. The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community. Collaborative Family Healthcare Association 12th Annual Conference

Learning Objectives At the conclusion of this session, the participant will be able to: Understand key training needs for an integrated behavioral health system. Describe how to set up an evaluation protocol to track performance outcomes of behavioral health consultants and health coaches. Outline steps to successful implementation of screening protocols and fidelity measures without disruption of the work flow. Construct a plan of action, including strategies to identify what outcomes should be measured, how to build necessary evaluation templates, and implement evaluation protocols. Include the behavioral learning objectives you identified for this session Collaborative Family Healthcare Association 12th Annual Conference

Bibliography / Reference 1. McDaniel, S., Hepworth, J., & Doherty, W. (2014). Medical family therapy and integrated care (2nd ed.). Washington, D.C.: American Psychological Association. 2. Hodgson, J., Lamson, A., Mendenhall, T., & Crane, D. R. (2014). Medical family therapy: Advanced applications. New York: Springer Miller, B. F., Gilchrist, E. C., Ross, K., Wong, S. L., Blount, A., Peek, C.J. (2016). Core competencies for behavioral health providers working in primary care. Prepared from the Colorado Consensus Conference. Gingerich, W.J., & Peterson, L.T. (2013). Effectiveness of solution- focused brief therapy a systematic qualitative review of controlled outcome studies. Research on Social Work Practice, 23, 266-283 5. Lundahl, B., Moleni, T., Burke, B., Butters, R., Tollefson, D., Butler, C., & Rollnick, S. (2013). Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials. Patient Education and Counseling , 93, 157 - 168 Continuing education approval now requires that each presentation include five references within the last 5 years. Please list at least FIVE (5) references for this presentation that are no older than 5 years. Without these references, your session may NOT be approved for CE credit. Collaborative Family Healthcare Association 12th Annual Conference

Learning Assessment A learning assessment is required for CE credit. A question and answer period will be conducted at the end of this presentation. Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements. Collaborative Family Healthcare Association 12th Annual Conference

Abstract This presentation will describe how one community health care system transformed from a model that included only one co-located mental health provider into a model that hasten behavioral health providers (BHPs) along with seven health coaches (HCs) all of whom were trained on specific research-informed interventions and integrated behavioral healthcare methods. To develop an effective and efficient integrated behavioral healthcare program, the following objectives were established: (1) to ensure consistency in the delivery of clinical interventions across BHPs and healthcare site (2) to facilitate BHPs’ and HCs’ learning of business practices appropriate for primary care settings, (3) to facilitate BHPs and HCs learning of effective collaborating operational policies and practices appropriate for a primary care setting, (4) to develop BHPs and HCs administrative skills that are compatible with a primary care setting, by integrating and adapting documentation procedures through the electronic health record system, and (5) to support BHPs and HCs adaptation to the primary care organizational culture through cross training opportunities. Additionally, an evaluation system was designed in order to ensure a minimum level of competency at the beginning of each BHPs entry into the system. This training and evaluation process also helped to ensure consistency in supervisory practices and promote fidelity in the model through consistent expectations for BHs and HCs progress. The use of evaluation metrics resulted in trainers and supervisors ability to identify training needs to address growth areas in a timely fashion. In order to promote sustainability for the model, metrics were constructed, implemented and analyzed in relation to the clinical, operational, and financial impact of the program.

Greene County Health Care Inc

Integrated Behavioral Health Care Services includes… Medical Family Therapy Services Health Coaching Services Care Management Primary Care and Dental Migrant Farm Outreach Program

Standardizing the IBHC Model 2006 – set up co-located model in one of five GCHC clinics 2007 – the model was expanded to the other patients in this community health center location to include IBHC 2008 – MedFTs were added to a third community health center location and by 2009, IBHC was at all of this community health center system’s locations 2011 – a pediatric practice was added to the community health center system 2013 – health coaches were added to care teams 2015 – HC and MedFT approaches to care were standardized; new templates, evaluations, and fidelity metrics were implemented

Greene County Health Care-research & Training * strengths and challenges * building an infrastructure for research/program evaluation/QI * Population health * Patient-centered outcomes * Fidelity Methods * Training and Supervision

Identifying Outcomes to be Measured Collaborate with administration and providers Review population health data Ensure that behavioral and mental health are present in the selected measures or options for analytics Run sample reports to make sure your system is compatible with your research/program evaluation expectations! So, we added social determinants of health items that are asked of all patients when establishing care or update their profiles via the patient portal We developed behavioral health goals and added tracking questions We learned that you have to be thinking like an analyst or statistician as you are building your EHR template…free text is not easily analyzed

Example of Analytics

Health Coach Evaluation Tool

Health Coach Evaluation Tool

Health Coach Evaluation Tool

Behavioral Health Provider Evaluation Tool

Behavioral Health Provider Evaluation Tool

Behavioral Health Provider Evaluation Tool

Health Coach Shadowing Checklist

Health Coach Shadowing Checklist

Health Coach Shadowing Checklist

Behavioral Health Provider Shadowing Checklist

Behavioral Health Provider Shadowing Checklist

Behavioral Health Provider Shadowing Checklist

Training Effectiveness Monitoring

Training Effectiveness Monitoring

Session Evaluation Please complete and return the evaluation form before leaving this session. Thank you! This should be the last slide of your presentation Collaborative Family Healthcare Association 12th Annual Conference