[PC-BH-Integration] PC-BH-Integrationprogram implementationobstacles

ann mahony agmpublichealth at gmail.com
Thu Jan 5 09:09:28 EST 2012

I meet with four CHC's in Chicago and DC to conduct "information exchanges"
about the status of behavioral health integration. I set these up OBO of
the health reform team of APHA's Alcohol, Tobacco, and Other Drugs Section
(ATOD) with a Chicago colleague. Our small sample reflects the finding Eric
reports below.

Ann Mahony
On Wed, Jan 4, 2012 at 11:40 PM, Eric Goplerud <Goplerud-Eric at norc.org>wrote:

>  I agree with Rodger.   We completed a survey for NACHC of integrated
> behavioral health services in FQHCs.   Integration was either mental health
> only or, the minority, mental health and substance use.   There was only
> one instance of a health center that had a substance use treatment provider
> on staff and no mental health staff.
>  Eric Goplerud
> Senior Vice President
> Substance Abuse, Mental Health and Criminal Justice Studies
> NORC at the University of Chicago
> 4350 East-West Highway, 8th Floor
> Bethesda, MD 20814
> 301-634-9525
> ------------------------------
> *From:* pc-bh-integration-bounces at lists101.his.com on behalf of Kessler,
> Rodger S
> *Sent:* Wed 1/4/2012 12:31 PM
> *To:* [National Council's Behavioral Health - Primary Care
> IntegrationListserve]
> *Subject:* Re: [PC-BH-Integration] PC-BH-Integrationprogram
> implementationobstacles
>  Sandy, Obviously agree completely. That said, the other side of the coin
> is also concerning. The field and survey data I am collecting suggests that
> in integrated primary care, it is really integrated mental health, with
> little or no attention to substance abuse. That does not work either. Rodger
> *From:* pc-bh-integration-bounces at lists101.his.com [mailto:
> pc-bh-integration-bounces at lists101.his.com] *On Behalf Of *Blount,
> Alexander
> *Sent:* Wednesday, January 04, 2012 12:10 PM
> *To:* [National Council's Behavioral Health - Primary Care
> IntegrationListserve]
> *Subject:* Re: [PC-BH-Integration] PC-BH-Integration program
> implementationobstacles
> This actually raises another "don't do it" and that is:  don't integrate
> only substance abuse services and not behavioral health even if the most
> acute need is around substances.  There was a conference recently in
> Washington sponsored by the White House Office of Substance Abuse (I don't
> have the name exactly right) and SAMHSA.  It included physicians and
> behavioral health folks, both from the specialty substance abuse field and
> from primary care. Some of the folks from the specialty world thought that
> integrating substance abuse into primary care as a program was a good
> idea.  None of the people, physian or behavioral health professional, who
> work in primary care thought that was a tenable idea.  It just continues
> the dichotomizing of patients, using a different dichotomy.  I hope you are
> in touch with the folks at the Hogg Foundation who have done so much work
> in promoting integrated care in Texas.  I suggest you look at starting
> again with a generalist approach and SA can be a part of that.
> Alexander Blount, EdD
> Director, Center for Integrated Primary Care
> Professor of Family Medicine and Psychiatry
> University of Massachusetts Medical School
> Director of Behavioral Science
> Department of Family Medicine and Community Health
> Editor,* Families, Systems, & Health*
> 55 Lake Ave, N
> Worcester, Massachusetts 01655
> O. 774.443.2147,   F. 774.441.7799
> alexander.blount at umassmemorial.org
> http://www.IntegratedPrimaryCare.com<http://www.integratedprimarycare.com/>
> http://www.umassmed.edu/fmch/faculty/Blount.cfm
>  ------------------------------
> *From:* pc-bh-integration-bounces at lists101.his.com [mailto:
> pc-bh-integration-bounces at lists101.his.com] *On Behalf Of *Linda Benitez
> Tavel
> *Sent:* Wednesday, January 04, 2012 11:01 AM
> *To:* pc-bh-integration at lists101.his.com
> *Subject:* Re: [PC-BH-Integration] PC-BH-Integration program
> implementationobstacles
> Good Morning Dr. Kern and colleagues,  I am in Texas and recently
> collaborated with a group of pain management physicians who reported
> concerns with their patients who exhibit drug seeking behaviors for other
> than pain management.  We discussed a co-located behavioral health care
> model whereby a behavioral health component could be co-located within
> their clinics to add substance abuse screenings, assessments, prevention,
> intervention and treatment services as part of their health care management
> plans, including drug screenings and breathilizers at each visit.  Due to
> the high incidence of prescription abuses that occurs within this
> population, and in our society, the doctors thought this would be a great
> idea.  Many obstables occurred with existing medical facilities policies
> and once we consulted with an attorney specializing in the area of health
> care law, it appeared that present Texas laws will not allow for this
> concept.  There are a couple of integrated primary care-mental health care
> models in Texas among non-profit entities but none with a primary
> care-substance abuse integrated model.  Within the area of substance abuse,
> co-occurring disorders often emerge and management of these mental health
> disorders have to occur simultaneously while treating addiction.
> According to NIDA MED, prescription abuse is quickly becoming a
> significant health care issue.  Present laws in Texas do not support the
> integration of private primary care, speciality care clinics with
> behavioral health care.
> Linda Benitez Tavel
> Vice President
> Amexica International Consultants
> Tel: 210-446-4606 ext 102
> Fax: 210-446-4549
> On Jan 4, 2012, pc-bh-integration-request at lists101.his.com wrote:
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> Today's Topics:
> 1. Re: One more plea for failures (Bradley, Wendy D)
> ----------------------------------------------------------------------
> Message: 1
> Date: Wed, 4 Jan 2012 04:23:36 -0900
> From: "Bradley, Wendy D" <wdbradley at SouthcentralFoundation.com>
> To: "'[National Council's Behavioral Health - Primary Care Integration
> Listserve]'" <pc-bh-integration at lists101.his.com>
> Subject: Re: [PC-BH-Integration] One more plea for failures
> Message-ID:
> <
> F7D46789D91A08489F0CC2629550F0481D39E2EA19 at SCFExch3.southcentralfoundation.com
> >
> Content-Type: text/plain; charset="us-ascii"
> Great lists so far....
> I will add
> 1) The best thing we ever did was to have the BHCs sit with the providers
> in the same space. They end up sharing work rather quickly because BHCs are
> able to show providers where they can be helpful and consults happen
> naturally throughout the day. Also, it reinforces that BHCs are part of the
> team and shifts the BHCs perception from traditional BH to the primary care
> culture.
> 2) I also cannot stress enough the importance of finding the right "fit'
> for this position. We have found that flexibility, strong communication
> skills (confidence), ability to be a team player and having a systems,
> solution-focused approach in clinical work is imperative.
> 3) Spend time making sure PCPs know how and are comfortable introducing
> BHCs to patients. (not as a saying therapist, social worker etc.)
> 4) Make sure there are "triggers" that get BHCs into the room. (i.e.
> screeners). This gets PCPs used to using BHCs.
> 5) Spend enough time training BHCs in the beginning. We have found
> "shadowing" is most helpful. Have them shadow all members of the PCP team
> (especially PCPs) to help them understand the culture. They should shadow
> BHCs and then be shadowed to ensure stated competencies.
> I attached a few tools we use.
> Wendy D Bradley, LPC
> Improvement Advisor-Clinical
> Organizational Development
> Southcentral Foundation
> Anchorage, Alaska
> wdbradley at scf.cc
> work 907 729-3378
> cell 907 250-9325
> From: pc-bh-integration-bounces at lists101.his.com [
> mailto:pc-bh-integration-bounces at lists101.his.com<pc-bh-integration-bounces at lists101.his.com>]
> On Behalf Of John Kern
> Sent: Friday, December 30, 2011 8:20 AM
> To: 'pc-bh-integration at lists101.his.com'
> Subject: [PC-BH-Integration] One more plea for failures
> My final act of 2011 will be to reach out again to all of you to share
> with me / us any experiences of failures so far in the implementation of
> your programs, things that you would recommend that others not do, to spare
> them your own personal agony.
> I am collecting these for a training presentation, and PROMISE that I
> won't use any identifying information without permission. AND that my own
> failures will be well-documented in the presentation - that's what makes it
> fun.
> Thanks in advance. Happy New Year!
> BTW, if you are willing to share, but not to the listserv, I am at
> john.kern at regionalmentalhealth.org
> John S. Kern, M.D.
> Chief Medical Officer
> The Regional Mental Health Center
> 8555 Taft Street
> Merrillville, IN 46410
> 219-736-7232
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Ann G. Mahony, MPH
Public Health Consultant
   & APHA ATOD Immediate Past Chair
301-581-0974 (o)
301-520-7734 (c)
agmpublichealth at gmail.com
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