National Council Magazine - Winter 2009 - 32

From the Field managers and clinicians using creative techniques to engage hard-to-reach consumers in lifesaving health interventions. As ICL works through the process of integrating care, we’ve learned that it is not only about consumers changing but also about staff becoming more comfortable addressing physical health issues with consumers and thinking about healthier choices in their own lives. LifeWorks Emphasizes Integration Across the Board Joe Hromco, PhD, Director of Clinical Operations, LifeWorks NW, Portland, OR joeh@lifeworksnw.org LESSONS LEARNED L ifeWorks NW has been fortunate to have several opportunities to integrate behavioral health and primary care services. Our largest collaboration, with the Virginia Garcia Memorial Health Center (a Federally Qualiﬁed Health Center), started with a grant from United Way and Providence Health and Services. It has graduated from a colocation project to an integration that includes “behaviorist” and substance abuse services. The project has particularly focused on Latinos, given the low penetration rates within the community. In addition to this project and other primary care efforts, we have begun a pilot project to provide healthcare services within a program for people with severe mental illness, focusing on metabolic syndrome. Resources and Services Administration−sponsored behaviorist statewide collaborative training, the National Council’s Primary Care/Behavioral Health Integration Listserv, a Primary Care Renewal collaborative sponsored by the local health plan CareOregon, a learning collaborative of behaviorists from area FQHCs, and a work group led by the state of Oregon focusing on larger system integration issues. Data for the projects have been quite positive. First, data on mental health outcomes have shown consistently positive rates of reliable mental health change (e.g., change on the Outcomes Questionnaire 45.2, ORS, and GAF). Second, we have routinely surveyed primary care physicians about their perception of behavioral healthcare — the surveys have shown consistent change in the areas in which we have focused and remained ﬂat in other areas. Last, data have shown improvements in penetration rates for Latino Medicaid members, a focus of our Virginia Garcia collaboration. Our next steps include expanding our collaboration from ﬁve primary care clinics to as many as ten. We are also working with an FQHC collaborative on building an integrated electronic medical record. In addition, we have begun earnest work in integration the “other way” bringing our physical healthcare partners into our programs for people with severe mental illness. It is important to consider the special skill and level of expertise of a behaviorist. Not just any mental health practitioner can fulﬁll this role. Good partnerships are key. Integration into primary care takes some time and requires full investment from physical and behavioral health. It is easy for behavioral health to be relegated to an out-of-site back room. Take the term integration seriously: Integrate staff into meetings, team rooms, and planning. Fully integrate the medical record. Use grants to launch the program, but plan right away on how to ensure sustainability after the grant ends. Resolve conﬁdentiality, records, billing, and credentialing issues early in any collaboration. Multiple resources have helped further our projects. For written materials, we have used the many resources of Blount (1998) Integrated Primary Care: The Future of Medical and Mental Health Collaboration, Haas’s (2004) Handbook of Primary Care Psychology, and Robinson and Reiter’s (2006) Behavioral Consultation and Primary Care: A Guide to Integrating Services. Many toolkits have been helpful, including the Substance Abuse and Mental Health Service Administration’s Screening, Brief Intervention, and Treatment; the Primary Care Evaluation of Mental Disorders; and locally derived clinical pathway materials. We have also beneﬁted from multiple trainings and collaborations: Health REFERENCES Blount, A. (1998). New York: Norton. Haas, L. J. (2004). Handbook of primary care psychology. Oxford, England: Oxford University Press. Robinson, P., & Reiter, J. (2006). Behavior consultation and primary care: A guide to integrating services. New York: Springer. In Missouri, Data Analytics and Primary Care Nurses Reduce Gaps in Medical Care Paul Stuve, PhD, Account Manager, CNS Care Management Technologies, Morrisville, NC / pstuve@cnsnet.com n response to rising concern over untreated chronic medical conditions and premature deaths in persons served by the public mental health system, Missouri implemented a statewide 32 / NATIONAL COUNCIL MAGAZINE • WINTER 2009 I disease management and primary care/behavioral healthcare integration initiative. The initiative used data analytics to reduce the fragmentation and gaps in medical care in combination with adding primary care nurses on site in community mental health organizations. In 2005, the Missouri Department of Mental Health partnered with Missouri Medicaid (now MO Health-

National Council Magazine - Winter 2009

Table of Contents for the Digital Edition of National Council Magazine - Winter 2009