Innovative Partnerships for Successful Integrated Health Care – A Texas Perspective

1. Session #H5b Saturday, October 12, 2013 Innovative Partnerships for Successful Integrated Health Care – A Texas Perspective Alejandra Posada, M.Ed., Director of Education and Training, Mental Health America of Greater Houston Rick Ybarra, M.A., Program Officer, Hogg Foundation for Mental Health Collaborative Family Healthcare Association 15th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A.

2. Faculty Disclosure I/We have not had any relevant financial relationships during the past 12 months.

3. Objectives • Identify at least three examples of successful, innovative organizational partnerships implemented by the Hogg Foundation’s IHC Grantees. • Identify at least three diverse types of organizations (i.e., beyond primary care and mental health providers) that may play important roles as partners in IHC programs. • Describe at least three processes and practices used to build and sustain successful partnerships. Describe how such processes and practices might be implemented in attendees’ own communities.

4. Planning & Implementation Grantees Los Barrios Unidos Community Clinic, Dallas Project Vida, El Paso Lone Star Circle of Care, Georgetown Centro San Vicente, El Paso Harris County Protective Services, Houston The Seton Fund, Austin The Center for Health Care Services, San Antonio Community Health Centers of South Central Texas Inc., Gonzales Mercy Ministries of Laredo, Laredo Nuestra Clínica del Valle, San Juan Planning Implementation Planning & Implementation

5. Partnership Possibilities The “classic” IHC partnership – A primary care organization and a mental health organization Additional partnership possibilities: • Higher education academic institutions • Hospitals/emergency rooms • K – 12 schools • Health information exchanges • Substance abuse providers • Other community/social service organizations

6. Partnerships with Higher Education Academic Institutions Lone Star Circle of Care (Georgetown, TX): • FQHC serving several counties in central Texas • Behaviorally-enhanced patient-centered health care home • Partnership with Texas A&M Health Science Center (TAMHSC) • LSCC operates a clinical “hub” at the TAMHSC College of Medicine facility in Round Rock, TX (Seton Family of Hospitals funded start-up costs for this clinical hub) • LSCC is an affiliate of the TAMHSC College of Medicine – LSCC doctors act as clinical faculty; medical students rotate through LSCC clinics • Similar partnerships with other academic institutions place students, interns, and residents at LSCC

7. Partnerships with Higher Education Academic Institutions Lone Star Circle of Care (Georgetown, TX): • Teaching partnerships include: • Texas A&M Health Science Center (medical students) • UT Southwestern (psychiatry and pediatric residents) • UT School of Social Work (master level social work students) • UT Department of Educational Psychology (PhD students and interns) • Texas State School of Nursing • UT nurse practitioner students • Austin Community College and other local CMA programs

8. LSCC Academic Partnerships (cont.) Partnership benefits for LSCC, academic institutions, and students/residents: • Students/residents learn about practicing in an integrated setting • Students/residents learn about practicing in a community health center setting with underserved populations • Students/residents and their schools benefit from the expertise of LSCC staff • The opportunity to serve as clinical faculty is a selling point in the recruitment and retention of staff for LSCC • LSCC benefits from the services provided by students/residents and also from the creation of a “pipeline” of potential future staff

9. Partnerships with Hospitals/Emergency Rooms Community Health Centers of South Central Texas (Gonzales, TX): • FQHC in south central Texas that partners with Bluebonnet Trails Community Services (local mental health authority) to provide integrated health care services • Strong “three-way” collaboration – CHCSCT, BTCS, hospital • High level of trust among the collaborating organizations; strong relationship among the three CEOs as well as among other staff • Health Care Coordinator hired with Hogg Foundation funding; works to strengthen relationships across the community • Collaborative focus on prevention/reducing ER utilization • Health Care Coordinator works with hospital nurses to promote referrals to CHCSCT, particularly for “high utilizers” • “Patient portal” allows hospital staff to access CHCSCT’s schedule online and make appointments for patients • Patient navigators placed in ER further enhance coordination of care

10. Partnerships with Hospitals/Emergency Rooms (cont.) Lone Star Circle of Care: • LSCC has partnered with area hospitals to coordinate care for uninsured patients • Area hospitals have awarded LSCC one-time grants to establish clinics • Increased access to primary care at a patient-centered medical home, complete with fully integrated behavioral health services, encourages more appropriate use of emergency services and thereby increases cost efficiency of care system wide • Due to this program’s success, area hospitals continue to partner with LSCC to open more clinics, sometimes co-branding clinics • After the initial grant to build and/or expand facilities, these LSCC clinics are fully sustainable and independently operated

11. Partnerships with/within Other Community Settings Harris County Protective Services (Houston, TX): • Has received Hogg Foundation funding for an integrated health care clinic for children in foster care • HCPS already had a medical clinic (staffed by a pediatrician through a partnership with the University of Texas Health Science Center) • Psychological evaluations have been provided through the Children’s Crisis Care Center (4Cs), but there has been little communication between the medical clinic, the 4Cs, and other providers

12. HCPS Partnership (cont.) • Very collaborative, intentional planning process for integrated clinic • Key components of plan (implementation to begin soon): • Coordination of care across the HCPS system (clinic, 4Cs, etc.) • Provision of psychiatry services (direct and/or consultation to pediatrician) through partnership • Hiring of a Care Manager • Future plans

13. HCPS CLINIC HUB MODEL Education Services HCPS Clinic HCPS Clinic Psych Services Juvenile Justice Services Parent Support Medical Exams Dental Exams 4C’s Screening Fetal Alcohol Screening Specialty Health Care Care Coordinator Specialty Dental Health Education Community CRCG

14. Key Processes and Practices in Successful Partnerships • Relationship-building • Intentional • Across all stakeholders – external and internal • Community perspective • Often requires a “change of lens” • Commitment/involvement of key individuals • Leaders, “champions,” and “point persons” • Intentional planning Texas Learning Community on IHC Evaluation Summary Report (Feb 2013) http://www.hogg.utexas.edu/uploads/documents/TLC%20Summary%20Report_final.pdf

15. Audience Discussion & Q&A What other kinds of innovative partnerships have you seen that benefit IHC? What other key processes and practices contribute to successful partnerships? How have such processes and practices been used – or how could they be used – in your communities?

16. For More Information Please also see the handout for more information about each of the Hogg Foundation’s IHC grantees, including contact information.

17. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!