Accelerating Reform Initiative

1. Accelerating Reform Initiative Developing Integrated care:Fayette Companies and Heartland Community Health Center Mike Bolye

2. Aim: Increase role in healthcare and position organization to be the preferred provider for medical referrals for substance use and mental health disorders to prepare for increased competition when health care reform covers those currently uninsured.

3. Changes • Nurse Care Managers and Wellness Coaches implementing health promotion activities: diet, exercise, smoking cessation • Specifications for an integrated PC/BH web-based patient registry developed • Integrated Health Center provides crisis BH services and a primary care clinic

4. Results Evaluation process for PCBHI and IHC finalized and approved by IRB; measures include: • Medical services received including preventive care and screening • Improvement in physical & BH health status: PHQ-9,BP, BMI,SF-36,Cholesteral • Reduction in ED utilization and arrests/jailing

5. Next Steps • Develop clinical algorithms for AUDIT DAST and train staff in implementation • Study implementation of computerized SBI • Implement BH brief individual Tx and groups at HCHC locations • Plan feasibility of HCHC assuming psychiatric services and MAT for addictions

6. Accelerating Reform Initiative Patient / Family Role AIM David Moore

7. AIM (Plan) GOAL: Increase the participation of families in the treatment process and engage them in learning how to support recovery. STRATEGIES: • Develop measures for baseline, tracking and process benchmarking. • Assess process and staff barriers to engaging families at all points in the tx continuum. • Implement engagement strategies across the continuum as well as “three tier” model in primary treatment.

8. CHANGE (Do) Measurement for Process Benchmarking • Developed new service documentation to accurately measure and track family engagement during tx. • Modified tx plan quality assurance tool to address family engagement and provide mechanism for feedback to staff. Process/Systems and Staff Assessment • Conducted focus groups to identify patient/family and staff barriers as well as “what works”. • Reviewed barriers with supervisors and identified first steps to resolve. • Additional training needed for staff and supervisors • Releases • Resistance from patient to involve family Implementing Engagement Strategies • Modified assessment tool to focus on engagement strategies at first appointment – obtaining releases and addressing resistance from patient to involve family. • Providing training on “three tier” model of engagement. Providing training on managing family sessions for staff. Have implemented family educational sessions. • Working with staff on tx planning for family engagement.

9. RESULTS (Study) Measurement for Process Benchmarking • Have begun to review individual staff family engagement rates – and working to identify particular practices with high performers versus low performers. Family Engagement TX Planning • All staff are receiving regular reports on family engagement indicators that were added to the tx plan QA tool.

10. Treatment Planning for Family Engagement

11. NEXT STEPS (Act) • Continue to look at ways to increase participation in family educational sessions as well as ways to engage families further after educational sessions. • Develop and conduct surveys for families • Plan for increased use of incentives

12. IMPACT – Lessons Learned • Attempts to engaging families must begin at the front door and continue throughout the tx process. • Much of our work has been working through patient’s resistance to getting family involved. • We have a long way to go………