Integration in the Field: County Initiatives

UCLA Integrated Substance Abuse Programs

Educational Objectives

• Provide background and discuss the importance of behavioral healthcare integration– facilitate understanding the key elements to moving

toward integrated care

• Describe three CA counties’ models of integration – share practical strategies to integrating substance

use, mental health, and/or primary care

Why is integrated care important?

• The annual rate of onset of mental health and addictive disorders is about 27%*

• Research findings consistently suggest that most people who seek behavioral healthcare do so from their primary care providers*

• Healthcare reform will result in an influx of patients with newly acquired SUD and MH treatment benefits seeking care in PC settings

*Strosahl and Robinson (2008)

Integration improves patient access to care.

– strengthens linkages between medical and behavioral health care

– improves continuing coordination of services

– improves the identification and linkage of patients to appropriate treatment

– blends interventions to treat the whole person rather than isolating a patient’s disorders

-Ohl et al. (2008)

Why is integrated care important?

What is “integrated healthcare”?- the collaboration of mental healthcare (MH), substance use disorder (SUD) treatment, and primary healthcare (PC) service providers to address a patient’s needs holistically and concurrently

CoordinatedServices

Co-locatedServices

Integration of services

IntegratedServices

MinimalIntegration

Basic Integration

at a Distance

BasicIntegration

On-Site

ClosePartially-

IntegratedServices

FullyIntegratedServices

Where can integrated care occur? • primary care settings• community health centers• federally qualified health centers• emergency rooms/trauma centers• prenatal clinics/OB-Gyn offices• medical specialty settings for

diabetes, liver and kidney disease, transplant programs

• pediatric clinics• college health centers• mental healthcare settings• substance abuse treatment centers

What are the key elements to successful integrated care?

• Mission Integration – providers across disciplines embracing a common goal

• Physical Integration – medical and behavioral health providers working in the same immediate area

• Clinical Integration – seamlessly connecting clinical activities of PC and BH providers

-Strosahl and Robinson (2008)

Key Integration Elements Cont.

• Operations Integration – PC and BH providers practicing within a shared infrastructure

• Information Integration – PC and BH provider sharing clinically relevant information in real time

• Financial and Resource Integration – financing integrated services using a blended pot of health care and mental health care resources

What barriers can we anticipate to successful integration?

• Differing priorities

• Differing philosophies

• Differences in training

• Different funding streams

• Documentation and privacy issues

Where can I find more information on healthcare integration?

The Integration Learning Collaborative

• Monthly teleconferences on special integration topics

• County showcases

• Integration resources and materials provided via e-mail and on the website

• Please contact Brandy Oeser at btoeser@ucla.edu if you are interested in participating

County Models of Integration

• Riverside County, Karen Kane

• Merced County, Manuel Jimenez

• Los Angeles County, Loretta Denering