Impacts of Integrated Health Care

1. Impacts of Integrated Health Care RESULTS Researchers and practitioners advocate for providing integrated health services to children in the U.S. to (a) meet their physical and mental health needs, and (b) address gaps in services. Recommendations center on the provision of mental health services in primary care settings to increase access to appropriate mental health services. This study examined factors related to integrated care in a facility that provides primary care and mental health services to youth. Indicators of the quality of integrated services included appointment logistics, client satisfaction, and staff-efficacy. Findings suggest that many youth were identified as having mental health concerns during medical appointments, highlighting the importance of having mental health clinicians on-site as opposed to sending the youth to another facility. This study underscores the need for increased capacity building in organizations to facilitate the examination of service provision and rigorous program evaluation. ABSTRACT INTRODUCTION METHOD Future research on integrated service provision could show the benefits of these services above and beyond traditional methods for physical and mental health care. To this end, future work could: Build capacity in organizations, with a focus on targeted data tracking and management. Organizations (and research in this area) would benefit from increased capacity to track information regarding the potential benefit of integrated services. Compare integrated with traditional services directly on appointment logistics, staff-efficacy, and client satisfaction. Include other measures, including client outcomes, rates of follow through on referrals, family dynamics, interpersonal relationship satisfaction, and school outcomes. Integrated careis collaborative, coordinated, and communicative care that occurs in the same location. Integrated Health Care Indicators Appointment Logistics:appointment characteristics and activities, including the number of referrals within and outside the facility, referral sources, and recommended form and location of treatment. Staff-Efficacy: providers’ belief in their capacity to perform their duties. The integrated service model can increase provider efficacy, and in turn, increase the quality of services provided. Client Satisfaction: satisfaction with multiple dimensions of service experience. Integrated services are thought to ultimately increase benefits to clients, which, in turn, should be reflected in high satisfaction ratings. FUTURE DIRECTIONS UNC-Charlotte1 and Teen Health Connection2 Melissa Strompolis1, Ryan P. Kilmer1, James R. Cook1, Donna Smith-Hogan2, Libby Safrit2, & Mason G. Haber1 WHAT IS INTEGRATED CARE? Co-location of medical and mental health services has been recommended to address the unmet mental health needs of children. However, limited information is available regarding the quality of care provided in integrated facilities. Children’s Health & Health Gaps Many children face a range of problems, including co-occuring mental health and medical problems. Gaps in services have been attributed to difficulty in receiving reimbursement, lack of options for children who do not meet diagnostic criteria, lack of communication between service providers and families, and lack of a focus on prevention. Integrating mental health services into primary care settings could address the physical and mental health needs of children and families and reduce gaps in services. Addressing Gaps through Integrated Services The majority of youth have contact with primary care settings which are desirable contexts for addressing youths’ mental health needs. Organizations must provide staff who can function within their range of competence in working with families. Mental health staff within the primary care setting is advantageous. DISCUSSION • Services were provided to clients who were referred for mental health services from outside locations and medical and mental health staff at THC. • Data collection procedures permitted tracking the number of times a medical staff member requested the presence of a mental health staff member (triage page)due to a concerns about a mental health issue (n = 248). • This finding underscores the potential benefit of co-located services, since a triage clinician could be pulled in to do an assessment, without requiring the youth to come back or go to another facility. • The staff-efficacy survey highlighted several views that may be of relevance in assessing the nature of the collaboration across different staff members. • 1. Both medical and mental health staff have experience and education in recognizing and referring for mental health issues. • 2. Both medical and mental health staff report confidence in making referrals based on their knowledge of the abilities of other staff • members to address mental • health issues. • Taken together, these • findings suggest that integrated services benefit from coordination, collaboration, communication, and confidence in other staff members. • Clients expressed high satisfaction with coordinated services by all • staff members and services provided by mental health staff. • Appointment Logistics • Most clients were referred through THC triage pages. • Most mental health referrals were for depression, family conflict, and academic concerns. • Individual therapy was the most commonly recommended form of treatment. • The information captured regarding appointment logistics highlighted the diverse locations from which THC received mental health referrals and to which THC staff referred. • Staff-Efficacy • Seven of 11 respondents worked primarily for mental health services. All respondents reported they were either extremely or somewhat confident in theirability to recognize mental health issues in clients. • “Having mental health providers right here on sight[sic] has been wonderful because you have someone you can talk to about what's going on with the patient.” • “My education and practical experience have made me confident in recognizing, treating, and/or making mental health referrals when appropriate.” • All respondents either strongly agreed or agreed that they had the knowledge to provide appropriate services and that clients benefited from receiving integrated services. • “By having both medical and mental health professions housed in the same setting, we are more able to effectively collaborate and offer multimodal treatment for teens with mental health and/or medical issues that may be impacting (or are impacted by) their social-emotional development.” • Client Satisfaction • Cronbach’s alpha for the client satisfaction survey was .94, indicating a high level of internal consistency (M = 61.29; SD = 10.16). • Overall, clients reported high • levels of satisfaction. The Context of the Present Study: Teen Health Connection (THC), Charlotte, NC THC integrates physical and mental health services and specializes in adolescents. Participants Appointment Logistics: most clients (N = 323) were < age 19 (88%), of African-American descent (59%), had Medicaid for insurance (55%), and were female (65%). Staff-Efficacy: (N = 11) 25-45 years old and all female. Client Satisfaction: (N = 15) ages ranged from 12-18 years; the majority were female (n = 9, 60%). Materials and Procedure Appointment Logistics. THC Staff tracked the age, race, gender, triage pages, insurance type, referral source, presenting reason, referral recommendation, service location, and diagnosis of each client at intake. Staff-Efficacy. THC staff completed 10 items assessing training in recognizing/referring mental health issues, and confidence in recognizing and referring for health issues. Client Satisfaction. On a survey developed specifically for this study, clients rated agreement with 18 items reflecting aesthetics, collaboration, and services. LIMITATIONS • Lack of access to protected health information • Could not link services received and client satisfaction. • Could not track THC clients from triage to services or assess treatment outcomes and client satisfaction over time. • Sample size limits generalizability