The Evolution of Integrated Healthcare at a Behavioral

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

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

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.

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

THE TRILOGY TEAM

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

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

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

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

WELLNESS SERVICES Exercise Nutrition Illness Management Self-care Education

PARTNERSHIPS Heartland Health Centers Rush University College of Nursing Chicago House

SUSTAINABILITY FQHC Billing Utilizing Students Maximizing reimbursement value

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

TECHNOLOGY Electronic Medical Records Sharing Information

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

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

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

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

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"

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

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

MANAGING WITH OUTCOMES Data Collection Monitoring Evaluation Dashboards & Reporting

Co-Morbidities and Disparities Biomarker or Disease Our Clients Nationally, individuals with SMI Overall Population BMI (n=486) Obese: 50% 60% of patients with bipolar disorder, 70% of patients with schizophrenia, & 55% of patients with depression Obese: 35. 7% Diabetes (n=776) 15. 7% 15%-18% of individuals with schizophrenia 11. 3% Tobacco Use (n=748) 54% 75% 18. 1% Blood Pressure (n=529) Hypertension: 22. 5% 21. 9% of adults identifying with any mental illness experienced high blood pressure Age 18 -39: 7. 3% 40 -59: 32. 4% 60+: 65% (Overall: 31. 4%)

Integrated Healthcare Outcomes Over 1, 000 clients 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 Hg. BA 1 C (diabetes management) 58% have improved cholesterol 18% have improved blood pressure 36% have improved Breath CO level (smoking cessation)

National Outcome Measures Results National Outcome Measures (n=440) Healthy Overall Functioning in Everyday Life No Serious Psychological Distress Use of Illegal Substances Use of Tobacco Products Binge Drinking Had a Stable Place to Live Attending school regularly and/or employed Involvement with Criminal Justice System Socially Connected Outcome Improved 19% 62% 14% 8% 4% 6% 14% 13% 2% 47%

Consumer Smoking Status 2012 38% 2014 Smoker 62% 46% 54% Non-Smoker

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

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

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

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

Questions?