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 Co-Located 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.

Administrative Data “Patient Pipeline” Referred for assess- ment All Patients Positive Screen Screened Assessed Positive Assessment Referred: on-site intervention Referred: off-site treatment No Shows Rec’d Inter- vention Rec’d Treat- ment

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

Examples of survey questions (out of 23)

* = Statistically significant difference in ratings between staff types

Questions / Comments?