Eugenie Coakley, Susan Grantham, Alec McKinney, Natalie Truesdell, Melina Ward May 4, 2012

 Describe quantitative findings for 2007 grantees ◦ # People assessed & referred for integrated services ◦ Clinical outcomes  Group discussion of the data ◦ Interpretation – what might the data mean? ◦ Assessment – what are the strengths/limitations of the data?  Format – Present and discuss (5 minutes, small groups) 2

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 14 Implementation projects funded by MeHAF starting in 2007, for three years ( ) ◦ Two ways (linkage mechanisms) were used to link Behavioral/Mental Health Providers and Primary Care Providers:  Referral/consultation (4 projects)  Co-location (10 projects)  Projects were implemented in a variety of sites (settings) – PC practices & CHCs; also B/MH offices, schools, emergency room, dental office 4

 The number of people who came in contact with integrated services (“reached”) as a result of these projects ◦ Assessed by a B/MH provider after screening for symptoms ◦ Referred for further services based on assessment and patient/provider discussion  Most referrals were to the assessing B/MH provider ◦ Treated in the form of further face-to-face visits with B/MH provider 5 Data Source: JSI’s Client Data Elements (CDE) Access data base

 7,364 people were assessed for integrated services ◦ 1,014 in 2 consultation projects ◦ 6,350 in 9 co-located projects  3,651 (57%) were referred for additional integrated services ◦ The other 43% - no need for further services at that time rarely was it noted in the CDE that patients refused a referral  Of those referred, most were treated over the course of 90 days after the referral: ◦ 41% (1,497) had multiple B/MH visits ◦ 18% ( 657) had one B/MH visit ◦ 41% (1,497) had no B/MH visits 6

7 IBH = integrated behavioral health

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 What are some ways you are interpreting these statistics? Questions raised?  What might cause the assessment trend line to increase and then decrease over time?  Is 59% of the patients having follow-up appointments “reasonable”? What ways might be used to verify/compare such findings? 9

 Focus on one dimension of effectiveness – client clinical outcomes  Measures selected by grantee, collected by sites ◦ Depression, anxiety, psychosocial health/functioning, physical health status, more reach statistics  JSI instructed data to be collected on those initially assessed and referred for additional IBH services 10

 Identifying the right people ◦ data system and staffing constraints  Picking the measurement that fits the conditions treated and understanding how to interpret it ◦ Initial severity determines the size of change score and the amount of time it takes to achieve a substantive change  Collecting multiple measurements ◦ patient participation in repeated measurement ◦ timing of follow-up measurement(s) ◦ impact on work flow  measurement for treatment vs. screening 11

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13 Selected Findings for 2007 Grantees with Limited Outcome Data

Data available for all youth served, using the Global Assessment of Functioning Scale 14 # YouthAvg. BL score Avg. # days F/U Avg. F/U score # clinically significant change School #12158 (46 to 70) …143 days… 60 (46 to 87) 1 Improved (mild to no sx) School #21962 (40 to 73) … 95 days… 63 (40 to 75) 1 improved (mod to mild sx) 1 worsened (mild to mod sx)

 Only 1 of 3 practices supplied data for half of the reporting period, representing 15/118 (13%) of assessed patients. 6/15 also had a follow-up measure. Measure: interpersonal/social role functioning 15

 Grantee 3: Data on PHQ-9 and GAD-7 for 313 adults indicates a lot of co-morbid depression and anxiety. 16

 What are some ways you are interpreting these results? Any questions?  Do you think these data are valuable? In what ways?  What advice do have to help strengthen the data? 17

18 Selected Findings for 2007 Grantees with More Complete Outcome Data

 PHQ-9 is part of routine care; completed at the start of every PC visit and prior to BH visits for those with depression.  The follow-up dated closest to 90 days after the MeHAF initial assessment was chosen for this evaluation; typically days later. ◦ All 3 clinics reported data ◦ 80% of 167 patients had an initial and follow-up assessment 19

20 Severe Moderate- to-Severe Moderate Mild None

21  50% reduction in symptoms OR PHQ-score <= 5 points attained by:  Site 1: 67% (22/33) people  Site 2: 34% (12/35) people  Site 3: 47% (30/64) people  Overall: 48% (64/132) people

22 Grantee 8: Sample table

 Outcome measure: change in weight  30 members agreed to be weighed monthly  Over the course of 6 months, 22 were measured 2-3 times  4 members’ goal – weight gain  18 members’ goal – weight loss 23

 The group needing to gain weight gained an average of 8.25 pounds ◦ 2 gained > 5 lbs. over 4-6 months ◦ 2 gained 1-5 lbs. over 1-2 months  The group needing to lose weight lost an average of 9.0 pounds ◦ 9 lost > 5 lbs. ◦ 1 gained > 5 lbs. ◦ 8 maintained weight +/- 5 lbs. 24

 How are you interpreting these statistics? What are the strengths and limitations?  Could you envision being able to collect this type of data at your site? Would it be useful?  Could this kind of data be helpful for securing additional funding? 25

 Access to integrated behavioral/mental health services was provided to over 7,000 Maine residents ◦ Nearly 60% were referred for additional services, and of these people, about 60% engaged those services  Measuring clinical outcomes was very challenging ◦ Able to show with initial assessment data that they were reaching high needs groups ◦ Mostly descriptive data; only in a few cases could the potential impact of services be estimated 26