Behavioral Health Navigator Presentation by Emerson Evans 12-12-13

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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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  • Background InformationPDHP was awarded a three-year grant from SAMHSA for the purpose of a Minority AIDS Initiative Targeted Capacity Expansion (MAI –TCE): Integrated Behavioral Health/Primary Care Network Cooperative Agreements.  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 CDC’s efforts through the ECHPP and is also part of SAMHSA’s Health Reform Strategic Initiative. 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. The expected outcomes for the program are:Reduce the impact of behavioral health problems, HIV risk and incidence, and HIV-related health disparities.  In response to SAMHSA’s 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.
  • Behavioral Health Navigator Presentation by Emerson Evans 12-12-13

    1. 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. 2. Philadelphia Integrative Behavioral Health Initiative (PIBHI) • Supported by Minority AIDS Initiative, who is supported by Substance Abuse Mental Health Services Administration (SAMSHA) • Bolsters goals and objectives of the National HIV/AIDS Strategy • Aims to improve HIV-related health outcomes • Part of the “12 Cities Project” (ECHPP) which funds HIV/AIDS services in the most heavily impacted areas throughout the country DHHS/SAMSHA PDPH/AACO PIBHI
    3. 3. A Population Based Behavioral Health Intervention Program Goals • Integrated provision of behavioral and primary healthcare • Reduce - HIV Incidence - Impact of psychosocial cormbidities - HIV related health disparities • Improve - Quality of life - Adherence - Viral load and CD4 measures - Retention in care - Risk reduction
    4. 4. Behavioral Health Consulting (BHC) Model at a Glance • Goal is to promote integration of behavioral health services within primary care team • Delivers high-volume, problem-focused care delivered in brief sessions • Treats any behaviorally-based problem • Has on-demand availability, fluid schedule • Provides immediate feedback to PCP on patient behavioral health difficulties • Looks to achieve key changes supporting HIV patients in large numbers • Goal is to improve PCP management of behavioral issues • Aims to improve the care milieu in HIV primary care
    5. 5. Behavioral Health Consultant Roles • Consultation to medical provider • Provide behavioral health integrated into an HIV clinical setting • Screen, triage, refer, and provide patient focused behavioral health intervention
    6. 6. The Philadelphia Integrative Behavioral Health Initiative Organizational Structure Project Administration – 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. 7. Certified Peer Specialist Roles • Implementation of client centered action plan aimed towards attainment of goals and autonomy • Assist with linkage to resources and community engagement
    8. 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. 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. 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. 11. Progress Continued… 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. 12. Lessons Learned • It is practical and feasible to provide a population based behavioral intervention • It is difficult to integrate behavioral health into a medical setting that itself is poorly integrated • Medical providers need updated training on psychopharmacology to increase competency levels in providing services • Collaboration among local, state, and federal institutions to eliminate barriers for reimbursement for innovate mental health interventions • The use of peers can be helpful in reducing resistance to behavioral health services and support retention efforts • The HIV positive population provides an appropriate outlet to integrate behavioral health and HIV care
    13. 13. Next Steps • Grant period ends September 2014 • Evaluation efforts have began - CAREWare - Collaboration with CBH - CESD Scores • Effects of the Affordable Care Act and it’s affect on mental health • Program sustainability - Funding - Funding Sources - Program structure - Institutional buy in

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