The Evolution of Integrated Healthcare at a Behavioral Health Organization in an Urban Community

1. The Evolution of Integrated Healthcare at a Behavioral Health Organization in an Urban Community Trilogy Behavioral Healthcare Chicago, IL Sara Gotheridge, MDAlice Geis, DNP, APN Chief Medical OfficerDirector of Integrated Healthcare Mary Colleran, MSW John Mayes, LCSW, CADC Chief Operations Officer President/CEO

2. Agenda • Who is Trilogy? • Defining the Need • The Integrated Healthcare Model • Program Outcomes • Challenges • Lessons Learned • Future Directions

3. Who is Trilogy? Trilogy’s mission is to assist people in their recovery from serious mental illness by helping them discover and reclaim their own capabilities and life direction.

4. Who Trilogy Serves • 950 clients currently When coming to Trilogy: • 48% of clients have co-occurring substance use issues • 75% of clients do not have a psychiatrist • 40% of clients do not have a primary care physician • 18% of clients are homeless • Average # of Primary Care encounters annually: 7 • Average # of Psychiatry encounters annually: 6 • Average # of Medications: 8

5. THE TRILOGY TEAM

6. The Need for Integrated Healthcare • Individuals with Serious Mental Illness (SMI) die on average 11-32 years earlier than individuals without SMI, almost always due to highly preventable or manageable medical co-morbidities • Stigma • Insufficient Access to Primary Care • Fragmented Health System • Complex psychosocial and biological conditions

7. The Integrated Healthcare Model EDUCATION CULTURE NURSING TECHNOLOGY PRIMARY HEALTH BEHAVIORAL HEALTH PARTNERSHIPS LEADERSHIP WELLNESS SERVICES CONSUMERS WORKFORCE PEER STAFF OCCUPATIONAL THERAPY SUSTAINABILITY SMOKING CESSATION OUTCOMES

8. CULTURE • Well-coordinated Care • Quality Care • Person-Centered • Shared Mission • Creativity • Flexibility

9. Primary Care Behavioral Health • Co-location • Layout of site • Workforce • Care coordination

10. WELLNESS SERVICES • Exercise • Nutrition • Illness Management • Self-care • Education

11. PARTNERSHIPS • Heartland Health Centers • Rush University College of Nursing • Chicago House

12. SUSTAINABILITY • FQHC Billing • Utilizing Students • Maximizing reimbursement value

13. WORKFORCE DEVELOPMENT • Academic Partnership • The Center for Integrated Healthcare Education • Peer Ambassadors

14. TECHNOLOGY • Electronic Medical Records • Sharing Information

15. PEER SPECIALISTS • What is a Peer Specialist? • Paid staff person who is willing to self-identify as a person with a serious behavioral health disorder with lived experiences. • Service Activities: • Peer mentoring/coaching • Recovery resource connecting • Facilitating & Leading Groups • Building Community

16. CONSUMERS • Consumer Advisory Council • WRAP (Wellness Recovery Action Plan) • WHAM (Whole Health Action Management) • Trauma-Informed Care

17. COMMUNITY OUTREACH • Wellness Fairs • Family Nights • World AIDS Day • Suicide Prevention Week • BBQs • Landlord Meet & Greet

18. OCCUPATIONAL THERAPY • Practice Apartment • OT Assessments: • Includes Hygiene, Cooking, Safety, Cleaning & Leisure Activities • Adaptive Devices • Involvement in Care Team

19. SMOKING CESSATION • Smoke-Free Campus • Participation in the American Cancer Society “Great American Smokeout” • Ask about tobacco use at every visit • Staff & client groups • Staff trained in Ask, Advise, Refer • Panelists on SAMHSA Webinar: "Craving Change: Implementing Tobacco Free Policies in Behavioral Healthcare"

20. LEADERSHIP • Frequent communication • Administrative & financial investment • Technological integration & data management • Build trust between partners • Focus on mission • Buy-in • Development Memoranda of Understanding • Clear policies, procedures and workflows

21. EDUCATION • The Center for Integrated Healthcare Education: • Pilot Course: “Integrated Behavioral Health, Primary Care, and Wellness: An Interprofessional Approach.” • Mental Health First Aid & Youth Mental Health First Aid • Certified Alcohol and Drug Counselor Training

22. MANAGING WITH OUTCOMES • Data Collection • Monitoring • Evaluation • Dashboards & Reporting

23. Co-Morbidities and Disparities

24. Integrated Healthcare Outcomes Over 1,000clients have participated in the Trilogy Heartland Integrated Healthcare program over the last four years. Of clients who completed the NOMs (National Outcome Measures) assessments: • 47% have an improved BMI (weight management) • 44% have an improved HgBA1C (diabetes management) • 58% have improved cholesterol • 18% have improved blood pressure • 36% have improved Breath CO level (smoking cessation)

25. National Outcome Measures Results

26. Consumer Smoking Status 2012 2014 38% 62% 46% 54%

27. Challenges • Need to continually redesign workflows • Need for staff training • Stigma • Inadequate space • Establishing efficient documentation process • Integrating technology

28. Addressing Challenges • Leadership Learning Community • Development of new financial model • Increase administrative support • Expand role of consumers • Increase relevance, accessibility & effectiveness of training • Include evaluation in program planning

29. Lessons Learned • Need for ongoing staff training • Be flexible & patient • Focus on qualitative results as well as quantitative • Take time to recognize successes • Focus on wellness

30. Future Directions • Sustainability • Enhancing performance measurement and reporting progress of the IHC • Identify high risk clients through reporting • Population Health Management • On-site Pharmacy Services • Marketing, and an emphasis on outcome materials • Northside Collaborative

31. Questions?