Deborah Scharf, PhD Co-PI / Project Director, PBHCI Multisite Evaluation Grantee Meeting

1. SAMHSA Primary & Behavioral Health Care Integration (PBHCI) Program “A Snapshot of Grantees andEarly Implementation Experiences” Deborah Scharf, PhD Co-PI / Project Director, PBHCI Multisite Evaluation Grantee Meeting May 17, 2012

2. RAND’s Role • Independent program evaluation • Jointly funded by ASPE / SAMHSA • Important opportunity to learn about the value of integrating PC & BH services for individuals with SMI and or SUDs • Create a roadmap for replication of the PBHCI program’s successes • Government-funded programs and/or individual agency efforts to integrate care

3. Evaluation Designed To Answer 3 Research Questions (RQs) RQ1 (Outcomes Evaluation): Does integration lead to improvements in the BH and PH of persons with SMI and/or SUD served? RQ2 (Process Evaluation): In what ways is it possible to integrate the services provided by PC providers and community-based BH agencies • i.e., what structural and clinical approaches to integration are being implemented? RQ3 (Model Evaluation): Which models and/or respective model features of integrated care lead to better behavioral and physical health outcomes?

4. Grantee Cohorts • Four (soon to be five!) cohorts of PBHCI grantees • Only cohorts I-III included in multisite evaluation *Cohort V grants not yet awarded

5. Overview • Cohorts I – III grantees – Brief review! • Early implementation experiences – Updated! • Population served – New! • Services provided – New! *BH = MH and/or SUD

6. Methods • Program-Level Data • Proposals • Structured telephone interviews or e-mails • Quarterly reports • Consumer-Level Data • TRAC • Registries

7. Assumptions • Multisite evaluation is ongoing! • Current data are incomplete • Analyses based on current data may be inaccurate • No accounting for: • Between-program differences • Clients, services, size, location, etc. • Selective attrition • PBHCI-specific factors (no control group)

8. Assumptions • Be patient! • Formal evaluation complete September, 2013

9. Snapshot of Grantees

10. Multisite evaluation grantee programs… • Represent multiple agencies and locations • PBHCI programs: N=56 • BH agencies: N=65 • BH locations: N=86 • BH agencies vary in capacity and size • Annual consumer volume: 1,585 (100 – 13,000) • Annual SMI volume: 1,000 (14 -9,800) • Total staff: 45 (5 – 400)

11. Are located in different environments • Urban (78%) • 26 states represented • n=13 states have 1 PBHCI grantee • AK, AZ, CO, GA, KY, MA, ME, MI, NH, OR, SC, UT, WV • n=13 states have multiple grantees

12. Provide multiple BH services

13. Primary care is provided by… • Partner agencies (78%) • FQHCs (67%) • Ann. pt volume: 15,000 (2,518 – 150,000) • Various distances from BH centers • M = 1.5mi (0 – 23)

14. Grants support multidisciplinary teams

15. Programs prioritize different clientele

16. Programs represent multiple models of integrated care

17. Models distinctive in name only • Most models share components • Implemented differently • No way to group programs by model type • Focus on model features instead • Shared or unique

18. Snapshot Summary • Many shared structural features • Urban settings, PC partner orgs (FQHC), providers co-located in BH setting, etc. • Many shared process features • Eligible clientele selected from larger pool, provision of outpatient and emerg BH services, EBPs (e.g., SBIRT) • Key program differences • Demographics, target populations, size of program, staff team, optional program features implemented • Rich, evaluation-worthy environment!

19. Challenges and Barriers to Program Implementation Start-Up and 1-Year

20. Challenges at Start-Up • Data collection (20%) • Recruiting, hiring, retaining qualified staff (32%) • Especially for rural programs (80%) • Sharing consumer information across provider groups (20%) • Licensing and/or approvals from agency administration, city, state, HRSA, etc. (20%)

21. Challenges at Start-up • Space for PBHCI activities (18%) • Administrative issues • e.g., billing and invoicing, dealing with patient insurance, agency reorganization (18%) • Merging PC and BH protocols, consumer recruitment (2-10%) • 7% reported no barriers

22. Challenges Present at Start-Up and Year 1

23. New Challenges at 1-Year Follow-up • Consumer recruitment (35%) • Engagement / retention in PBHCI (24%) • Adequate capacity to serve consumers (16%) • Access to specialists (<7%) • Transportation for consumers (<7%) • Consumer payment / insurance (<7%)

24. Consumers Served

25. Consumer and Process Data • Calendar year 2011 • Consumers in TRAC and Registry • >85% of recorded individuals in this window • Reminder • Unofficial results • Interim update only

26. Consumers Served Last Year Total Consumers Served: 12,508

27. Consumer Demographics *Consumers could endorse >1 race

28. Consumer Psychosocial Characteristics

29. “At Risk” for Chronic Physical Illness

30. “At Risk” for Chronic Physical Illness

31. Services Received

32. Consumer Contacts with Multiple Provider Types

33. Consumers Receiving PH Services

34. Consumers Receiving MH Services

35. Consumers Receiving SUD Services

36. Consumers Receiving Wellness Services (Select)

37. Consumer Satisfaction

38. A few take-home points

39. Multisite Evaluation Programs are Up and Running! • Hundreds of consumers served per site • Thousands served across the entire program • Rich, diverse clientele • Many, many PH needs • Most at risk for metabolic syndrome • Programs offer a wide array of services • Most consumers receive PH and MH services • Few receive SUD services beyond screening • About 1 in 3 has no contact with case mgr • Consumers are satisfied with PBHCI care

40. PBHCI Multisite Evaluation is in Progress • PBHCI grantees are pioneers • Programs are multifaceted • Data collection is complex Let us honor your hard work with careful, comprehensive, accurate data analysis • Significant, nation-wide impacts of PBHCI • Model for future integrated care initiatives • Health Homes, Specialty Health Homes etc.

41. Continuous Quality Improvement • Further work needed in the areas of • Consumer recruitment (by grantee report) • Engagement / retention • Capacity building • Specific service types

42. If you have additional questions related to the PBHCI national evaluation… • Participate in related break-out sessions • Send questions to Center for Integrated Health Solutions • Participate in future Data Jams • Approach me!

43. THANK YOU!

44. Programs include many optional model features

45. SBIRT and MI are common EBP