Co occurring Disorders Treatment Integration. Kitsap County Substance Abuse Advisory Board Cheryl Mogensen MA, MHP, CDP December 10, 2013

Transcription

1 Co occurring Disorders Treatment Integration at KMHS Kitsap County Substance Abuse Advisory Board Cheryl Mogensen MA, MHP, CDP December 10, 2013

2 Kitsap Mental Health Services Bremerton, Washington Comprehensive behavioral health for children, adults, older adults with acute or persistent Serious Mental Illness/Serious Emotional Disturbance Sole countywide community behavioral health agency Offer inpatient, outpatient, and residential services Operate as sub capitated, at risk, Medicaid BH system Financial incentives of capitated, at risk system align to support provision of early, most appropriate level of care, and coordination of care with ancillary providers

3 Where We ve Been Building on an existing system of care for behavioral health and physical health to improve health of persons with SMI/SED CMS/CMMI Award Co locate PCP on KMHS campus 1995 KMHS Psychiatric consultant/brief interventionist at FQHC 1993 Co occurring substance use disorder specialty program at KMHS County Contract: Youth 1994, Adults KMHS mental health outpatient, inpatient, and residential treatment

4 What We Wanted to Do 2012 Whole Person Care Fully integrate mental health & substance use disorder treatment Tighter care coordination with patient s PCP/health home Chronic disease self management/health promotion programs Seamless transition of patients between levels and types of care Bi directional primary care/behavioral health care model right care, right place, right time to meet the Triple Aim

5 Physical Illness Takes Early Toll 100% Cohort 1 Comorbidities 90% 80% 70% 60% 50% 40% 30% 20% 23% 27% 58% 52% 48% 18% 32% 37% 67% Cohort 1 10% 0% Persons with serious, persistent mental illnesses die up to 25 years sooner than persons who do not have a mental illness

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7 What s Made It Possible Catchment Area sole provider Partners Staff Payment structure Sub capitation, at risk for mental health services County flexible substance use disorder funding Waiver of State substance use disorder regulations Restructure to multi disciplinary Care Teams CMS Innovation Center funding Health information & data sharing Cross training Bi directional care model

8 What We Know Co occurring Disorders are common Co occurring Disorders are associated with negative outcomes Separate care is ineffective

9 How Substance Abuse, Mental Health and Physical Health Problems are Related Self medication to ease problems Substance abuse may make mental and physical health problems worse The risk of underlying mental illness or physical health problems may increase with substance abuse

10 What are Integrated Services? COD services mean the same clinicians (or teams of clinicians), working in the same setting, provide combined or integrated interventions, treatments and programs for mental illness and substance abuse. Integrated treatment is more than just combining treatment for mental illness, physical health and substance use disorder. It also involves modifying traditional interventions. The goal of integrated treatment is for the client to recover from two or more serious illnesses.

11 Guiding Principles of Treatment For Clients with COD Employ a recovery perspective Adopt a multi problem viewpoint Develop a phased approach to treatment Address specific real life problems early in treatment Plan for the client s cognitive and functional impairments Use support systems to maintain and extend treatment effectiveness. 11

12 Recommended Best Practices Integration of Services Comprehensiveness of Services Assertive Engagement Reduction of Negative Consequences Long Term Perspective Motivation Based Treatment Multiple Psychotherapeutic Modalities Specialized COD Services 12

13 Evolution of Integrated Treatment at KMHS Previous: 1 2 COD Clinicians provide COD services for all clients Pathways as stand alone program with full team of COD clinicians Pathways COD Clinicians as consultants to other teams while part of their own program Now: Pathways COD Clinicians embedded in Adult OP Teams.5FTE Child and Family COD Clinician added 1 FTE Child and Family COD Clinician embedded In Development: Consultation Services to Residential and Inpatient Programs Consultation Services to Older Adult Services

14 What We Are Doing Multidisciplinary Care Team Restructure Care Team Supervisor Housing, Employment Community Integration Specialist SUD Co occurring Professional Groups & Individual Interventions & Consultations MA/MS Therapists Therapy & Care Coordination Patient s Care determined by needs integrates MH, SUD & chronic disease mgmt Daily Huddles communication for shared clients Program Assistant Evaluation, Treatment, Prescribing.5 Psych Medical Provider Patient BA/BS Case Managers Care Coordination & Ancillary Services BH/Co morbidity management.5 Psych Nurse NEW Medical Assistants Primary care linkage Health Analytics

15 Providing Whole Person Care Embed Substance Use Treatment agency wide Substance Abuse Physical Health Mental Health MH/SUD Integration: cross train all staff for fully integrated BH treatment Add Chronic Disease/Health Promotion Program New: individual & population based approach; patient registries; EBP Practices (PAM,WHAM). Add Bi directional Care Model with Primary Care Recovery model: facilitates flow between PCP/CBHC sites for level of care needed to support recovery Workforce higher education Prepare future workforce: allied health/bh professions educated for whole person integrated care

16 Health Analytics Inform Care Shared Health Data Becomes Information Real time data informs Treatment Tighter care coordination with PCP s, ED s, hospitals Measures Care Management Reports PATIENTS Care Team Medical Assistants HEALTH ANALYTICS KMHS EHR Patient Registries Onsite PCP Community PCPs PRISM EDIE HERO HIE Rx Monitoring ED s

17 Bi directional Care Model CBHC Psychiatric consultation for all PCP s supports rapid diagnostic, med management, training CBHC BHP co located in PCP offices for low/ moderate BH needs & to coordinate access as needed to specialty BH services PCP co located on CBHC supports BH patients who prefer PCP services on BH site Supports seamless patient flow between systems of care as needed Increases patient information sharing for care coordination Natural occurrence of cross training between disciplines PCP informs CBHC practice; CBHC informs PCP practice Provides right place, right care, right time and recovery model for SMI/SED patients Community Based Primary Care Providers /Health Home Community Behavioral Health Center On Demand CMHC Psychiatric Consultancy & On site BHP Co located PCP on CMHC campus

18 EBP and Evolving Practices Adult Services Integrated Dual Diagnosis Treatment Trauma Informed Care Illness Management and Recovery Matrix Seeking Safety Women in Recovery Men in Recovery Living in Balance COD Anger Management Seeking Safety Medication Assisted Treatment Peer Support Recovery Groups AA, DRA Cognitive Behavioral therapy Motivational Interviewing

19 EBP and Evolving Practices Child and Family CRAFFT Screening Tool Change Companies Interactive Journaling Claudia Black s Family System Approach Adolescent Co occurring Disorders Curriculum Seeking Safety Children of Addiction Curriculum Coping and Support Training Medication Assisted Treatment Cognitive Behavioral Therapy Dialectical Behavioral Therapy Motivational Interviewing

20 Benefits of Embedding Improved coordination of care Increased options for just in time training Increased awareness of COD issues Easier access to consultations Proximity makes a big difference

21 Challenges to Whole Person Care Artificial, forced, internal silos due to funding Integrated care requires a regulatory environment and data systems across all providers to support integration Need a payment system that braids all 3 facets of physical, mental, substance use disorder treatment The better we do our work, the harder to maintain silos!

22 Future Needs for Integration Goals Earlier identification and intervention for substance use issues Increased training for all staff to improve COD capability across all programs Additional Adult COD clinicians to support all teams including ACCESS, CIS, OAS, Inpatient and Residential Services. Additional Youth COD Clinicians to support the need for prevention and treatment interventions for all at risk youth Improved access and utilization of adjunctive addictions medications earlier in treatment for more clients.

23 Future Needs for Integration Goals Recovery Supportive Housing Peer Support Program Increased ability for assertive outreach Methadone and Suboxone Treatment options in Kitsap County Essential: Capitated funds that will facilitate a single system of care

24 How the County has Assisted our Integration Innovation Efforts Understanding and supporting the importance of this work Providing ongoing flexible funding Willing to partner with us to workaround or overcome funding and regulatory barriers Partnering with us to extend services to the community on many levels.

25 Additional Information Joe Roszak, Executive Director Elena Argomaniz, Project Director Rochelle Doan, Development Director Cheryl Mogensen, Integration Consultant (Portions of) the project described was supported by Funding Opportunity Number CMS 1C from Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.