Emerson Evans (AACO) presented on a SAMHSA-funded behavioral health navigator program on 12-12-13. This program in Philadelphia was discussed with the Philadelphia EMA Ryan White Part A Planning Council.
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Behavioral Health Navigator Presentation by Emerson Evans 12-12-13
1. The Philadelphia Integrative
Behavioral Health Initiative
Emerson Evans
SAMHSA MAI-TCE Project Coordinator
City of Philadelphia Department of Public Health
AIDS Activities Coordinating Office
December 12th, 2013
2. Philadelphia Integrative Behavioral Health
Initiative (PIBHI)
โข Supported by Minority AIDS
Initiative, who is supported by Substance
Abuse Mental Health Services
Administration (SAMSHA)
โข Bolsters goals and objectives of the
National HIV/AIDS Strategy
โข Aims to improve HIV-related health
outcomes
โข Part of the โ12 Cities Projectโ (ECHPP)
which funds HIV/AIDS services in the most
heavily impacted areas throughout the
country
DHHS/SAMSHA
PDPH/AACO
PIBHI
3. A Population Based Behavioral Health
Intervention
Program Goals
โข Integrated provision of behavioral and primary healthcare
โข Reduce
- HIV Incidence
- Impact of psychosocial cormbidities
- HIV related health disparities
โข Improve
- Quality of life
- Adherence
- Viral load and CD4 measures
- Retention in care
- Risk reduction
4. Behavioral Health Consulting (BHC) Model at
a Glance
โข Goal is to promote integration of behavioral health services within primary care team
โข Delivers high-volume, problem-focused care delivered in brief sessions
โข Treats any behaviorally-based problem
โข Has on-demand availability, fluid schedule
โข Provides immediate feedback to PCP on patient behavioral health difficulties
โข Looks to achieve key changes supporting HIV patients in large numbers
โข Goal is to improve PCP management of behavioral issues
โข Aims to improve the care milieu in HIV primary care
5. Behavioral Health Consultant Roles
โข Consultation to medical provider
โข Provide behavioral health integrated into an
HIV clinical setting
โข Screen, triage, refer, and provide patient
focused behavioral health intervention
6. The Philadelphia Integrative Behavioral Health Initiative
Organizational Structure
Project Administration โ AACO
Partner A
Partner C
Behavioral
Health
Consultants
Certified
Peer
Recovery
Coaches
Partner B
Patient(s)
HIV Specialty Clinics (9) Integrated Provision of HIV
Primary Care and Behavioral
Health Services
External Services
Peer recovery
coaching
Workforce
development,
capacity building
7. Certified Peer Specialist Roles
โข Implementation of client centered action plan
aimed towards attainment of goals and
autonomy
โข Assist with linkage to resources and
community engagement
8. Mental Health Clinical Presentations
Mental Health Impression % of BHC patient population (Frequency)
Depression 42.1 % (584)
Anxiety 10.5% (146)
Bipolar 3.5% (48)
Psychopathy, Sociopathy <0% (1)
Psychotic Symptoms 1.7% (23)
Other 26.5% (368)
None 15.6% (216)
Total 100% (1387)
Predominant Diagnostic Mental Health
Impression
***This table contains unduplicated BHC patients from clinic start date up until March 31st
, 2013***
9. Substance Abuse Clinical Presentations
Substance Percentage (Frequency)
Marijuana 4.5% (62)
Alcohol 4.4% (61)
Cocaine 4.75% (66)
Heroin <1% (9)
Benzos <1% (2)
Meth <1% (3)
Other Opiates (pain killers) <1 % (3)
Other substances 3.6% (50)
Multiple substances 3.5 % (48)
None 77.4% (1074)
Total 100% (1387)
Diagnostic Substance Abuse Impression
***This table contains unduplicated BHC patients from clinic start date up until March 31st
, 2013***
179 898
35 275
Substance Abuse and Mental Health Comorbidities
-
+
- +Mental Health
Substance Abuse
10. A Population Based Behavioral Health
Intervention
BHC Clinic Penetration
Clinic BHC Start Date # Patients # BHC Patients % Penetration
Clinic A June 2012 1039 432 41.6%
Clinic B May 2012 731 316 43.2%
Clinic C June 2012 731 370 50.6%
Clinic D September 2012 948 333 35.1%
Clinic E August 2012 1080 270 25.0%
Clinic F May 2012 1677 580 34.5%
Total 6206 1798 28.97%
*Data as of 10/31/13
11. Progress Continuedโฆ
Screened 2301 (37.1%)
2nd Visits 982 (42.7%)
3+ Visits 581 (59.1%)
Philadelphia Integrative Behavioral Health Initiative Totals
Oct 2012-Oct 2013
12. Lessons Learned
โข It is practical and feasible to provide a population based behavioral
intervention
โข It is difficult to integrate behavioral health into a medical setting
that itself is poorly integrated
โข Medical providers need updated training on psychopharmacology
to increase competency levels in providing services
โข Collaboration among local, state, and federal institutions to
eliminate barriers for reimbursement for innovate mental health
interventions
โข The use of peers can be helpful in reducing resistance to behavioral
health services and support retention efforts
โข The HIV positive population provides an appropriate outlet to
integrate behavioral health and HIV care
13. Next Steps
โข Grant period ends September 2014
โข Evaluation efforts have began
- CAREWare
- Collaboration with CBH
- CESD Scores
โข Effects of the Affordable Care Act and itโs affect on mental health
โข Program sustainability
- Funding
- Funding Sources
- Program structure
- Institutional buy in
Editor's Notes
Background InformationPDHP was awarded a three-year grant from SAMHSA for the purpose of a Minority AIDS Initiative Targeted Capacity Expansion (MAI โTCE): Integrated Behavioral Health/Primary Care Network Cooperative Agreements. ย This grant program:Is part of the Congressional Minority AIDS Initiative. Supports the goals of the National HIV/AIDS Strategy, the HHS 12 Cities Project, (Nancy will have the list of cities) and the CDCโs efforts through the ECHPP and is also part of SAMHSAโs Health Reform Strategic Initiative.ย The purpose of the MAI-TCE program is: Facilitate development and expansion of culturally competent and effective integrated behavioral health and primary care networks within racial and ethnic minority communities.ย The expected outcomes for the program are:Reduce the impact of behavioral health problems, HIV risk and incidence, and HIV-related health disparities. ย In response to SAMHSAโs RFA, the Integrated Behavioral Health Initiative was born.
SUSAN SPENCER
Promote integration of behavioral health services within primary care teamDelivers high-volume, problem-focused care delivered in brief sessionsTreats any behaviorally-based problemHas on-demand availability, fluid scheduleProvides immediate feedback to PCP on patient behavioral health difficultiesLooks to achieve key changes supporting HIV patients in large numbersGoal is to improve PCP management of behavioral issues\Receive patient referrals from medical providers and other clinic staffRefer out for substance abuse t and mental health treatment and supportive services
Promote integration of behavioral health services within primary care teamDelivers high-volume, problem-focused care delivered in brief sessionsTreats any behaviorally-based problemHas on-demand availability, fluid scheduleProvides immediate feedback to PCP on patient behavioral health difficultiesLooks to achieve key changes supporting HIV patients in large numbersGoal is to improve PCP management of behavioral issuesReceive patient referrals from medical providers and other clinic staffRefer out for substance abuse t and mental health treatment and supportive services
Screened are the number of patients who have received at least one visit from the BHC. 2nd visits are only 2nd visits. Some patients have been seen as many as 8 times by the BHC. Unduplicated referrals is 769 separate individuals referred to ancillary mental health and substance abuse treatment services. Note that at Drexel, there is an on site Psychiatry unit which has proven to be beneficial for that clinic. To date, there have been a total of 62 clients receiving peer recovery services. IIf asked about year 1 numbers:574 Total clients456 initial visits/screenings118 2nd visits or more564 total sessions
It has been difficult to integrate our model into some of the infectious disease clinics. Essentially our model is changing a culture in the clinics and this change has operated differently at the clinics and has met some challenges. Communication and consultation between medical providers and BHCs is essential to the model and some of the medical providers have not been consistent or interested in providing referrals. Also at some of the academic medical clinics where providers are researchers, they are not fully invested in the clinics themselves.
The grant period ends at the end of federal fiscal year 2014 (September) with the possibility of an extension. We have began evaluation efforts to determine if our program is effective in providing behavioral health in an HIV clinical setting that can influence improved patient outcomes such as viral load, CD4 count, and linkage to care. We will be using a custom service for BHC in CAREWare to facilitate our efforts in addition to Center for Epidemiology Scale of Depression which is available at two of our clinical sites. Also we are collaborating with CBH so that they grant the authority for behavioral health consulting to be a billable service for Medicaid. It is unforeseen how the implementation of the ACA will influence the sustainability of our project however, it is important to mention. As the ACA will ideally increase access and utilization of health systems, it is possible for funds to be allocated to improve the mental health and substance use infrastructure. We saw this earlier in the week as VP Biden pledged 100 million to mental health in the country. While this is not nearly enough, it is a start.