1. Integrated Learning Collaborative
Treatment of Substance Use and Mental Health Disorders in Primary Care in the Era of Health Reform
February 22, 2012

2. 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

3. What Does Our County Look Like?
Mental Health System of Care
Substance Abuse System of Care
FQHCs

4. What MHSA Opportunities are Provided?
Integration
Workforce
Two services in same day
Address both MH and SUD
Time

5. Spoken Goals Universal screening Brief interventions
Technology via health registries

6. 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

7. What is the Model? Universal screening
Brief consultation in the exam room
Brief interventions
Integrated case conferencing
Using data to monitor progress

8. 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

9. Current Barriers Fear of recognizing the SUD patient
Filing in the medical record
Charting in the medical record

10. Health Information Exchange
42 CFR Part 2 requires:
Individual consent
Specificity
Prohibits re-disclosure
Between primary care and specialty
Diagnosis
Lab results
Medications

11. UCLA and Evaluation Prevalence
Baseline with the Dual Diagnosis Capability in Health Care Settings (DDCHCS) tool
The pipeline using i2i data
Perceptions and attitudes

12. Prevalence Preliminary Results
Prevalence of depression
Prevalence of thought disorders
Prevalence of alcohol and drug

13. 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.

15. 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

16. Staff Perceptions & Attitudes
Surveys
Adapted from surveys developed by the Integrated Behavioral Health Project (
Multiple versions used:
Behavioral Healthcare Provider Satisfaction Survey
Primary Care Provider Satisfaction Survey
Primary Care Provider Satisfaction Survey - Non PCP Staff

17. Examples of survey questions (out of 23)

18. * = Statistically significant difference in ratings between staff types

19. Questions / Comments?