Last Wednesday, March 10, the Integration of Health and Behavioral Health Workgroup heard from 22 programs that have integrated health and behavioral health to some extent in Texas. Our day started at 8:00 a.m. and went until 5:00 p.m. with very minimal breaks and a working lunch. My only wish was that the chairs had been more comfortable for this marathon. What a wealth of experience we have to benefit from! Let me tell you about our presentations:
SUPPORT Program – FREW Strategic Initiative (Program created as part of the settlement to a class action law suit against the state due to problems in screening and access to care for children in the Texas Medicaid program). This program puts a master’s level Licensed Professional of the Healing Arts, or LPHA (LCSW or LPC) in a demonstration project in 9 pediatric practices around Texas.
STAR Health – Superior Health Plan (Physical Health) and Integrated Mental Health Services (Behavioral Health) are co-located in teams throughout Texas and work together in a team process to serve all the foster children under the Texas Department of Family and Protective Services in a contract with Medicaid.
Galveston County School-based Community Systems of Care – A program coordinated by UTMB that encourages community partnerships with UTMB, the local mental health center, community-based social service agencies and the local school districts.
Psychiatric Advanced Practice Registered Nurses in Integrated Health – This was not one program, but a description of how APRNs participate in integrated health settings in Texas and the nation. This classification was created to deal with the shortage in psychiatrists.
CommUnityCare/Austin Travis County Integral Care E-Merge Model – A collaborative care model that uses bilingual master’s level and beyond therapists (maybe one psychologist) within the Federally Qualified Health Centers (FQHCs) in Travis County.
Integrated Behavioral Health Program People’s Community Clinic (Austin) – Collaborative care model in which the primary care provider works with a care manager, or Behavioral Health Specialist ( in this case a Master’s level social worker) to develop and implement a treatment plan for patients diagnosed with anxiety or depression.
Project Vida Health Center, Integrated Health Care Program (El Paso) – One of the 5 programs funded by the Hogg Foundation for 3 years in 2006 to demonstrate the collaborative care model. It puts a care manager, behavioral health specialist (usually a social worker) in the primary care or pediatric setting.
El Paso MHMR and El Paso First Health Plans (HMO) Integrated Health Care Initiative – Provides integrated care to 40 children and adults who receive services from both agencies. LCSWs, LPCs and RNs from each respective agency identify and treat individuals with co-morbid concerns through a co-case management model.
Harris County Hospital District Community Behavioral Health Program – Puts psychiatrists and mostly LCSWs in 16 primary care centers/programs across Harris County. Includes involvement with medical students, psychology interns, primary care residents, and psychiatry residents.
Lone Star Circle of Care: Behaviorally Enhanced Community Health Center Network (Williamson & Travis Counties) – This program embeds behavioral health specialists (psychiatrists, psychologists, LPCs and LCSWs) in pediatrics, family practice and adolescent medicine clinics in Williamson and Travis Counties. They also have 3 Behavioral Health Clinics.
UTHSC at San Antonio: Lessons Learned from a clinic-based research in integrated family ad medicine clinic – U.S. Air Force program at Lackland Air Force Base that uses a Behavioral Health Consultant (BHC) model. BHCs are psychologists or psychology interns that work in family medicine and OB/GYN clinics. Research programs were initiated to examine patient outcomes.
AMERIGROUP Community Care Case Management – Program throughout Texas that provides enhanced case management to members of the plan with co-morbid physical and behavioral health conditions.
NorthSTAR Integrated Health and Behavioral Health Intensive Case Management for High Risk/High Cost Homeless Individuals – ValueOptions implemented an integrated Behavioral Health and Physical Health intensive case management program as part of the co-located services available at the City of Dallas Bridge homeless shelter. The program is aimed at individuals who had frequent emergency room visits.
Continuum of Care model (Galveston) – This collaborative effort, led by UTMB Galveston and the Gulf Coast Center for MHMR Services (GCC), provided a holistic approach to service delivery. The intent was to offer support and referral among sites while re-connecting all GCC clients back into GCC services. GCC placed case managers at public health clinics, jails, faith-based social/health agencies, and the in-patient psychiatric hospital at UTMB. Unique to this model was the use of the GCC mobile response teams who worked with case managers to overcome transportation barriers and critical situations and improve medication and appointment compliance.
East Texas Integrated Health-Care Project – Community Healthcore and two area partners are working on two different fronts to achieve improved primary and mental health care for individuals in the local communities. This collaborative effort began with East Texas Border Health in Marshall, Texas and the development of an FQHC. It began with Community Healthcore and spun off with its own board.
Outcomes of the Texas SBIRT Program (Harris County) – A Screening, Brief Intervention and Referral to Treatment (SBIRT) program for alcohol and drugs was conducted at multiple locations (emergency centers, hospital inpatient and outpatient departments and community clinics) within the Harris County Hospital District.
St. Edward’s University (Austin) – In March 2009, SEU opened an integrated center for delivering medical and mental health services to their university student population. The new facility, named the Health & Counseling Center, replaced the former Student Health Center and the Counseling & Consultation Center. The merger planning for these two separate departments spanned three years—with very intensive efforts conducted during the final 18 months before opening.
Peer Wellness Coaching Role to Promote Health in Persons Living with Severe Mental Illness – A proposed model developed by nutritionist and others at the Institute for Wellness and Recovery Initiatives Collaborative Support Programs of New Jersey. Wellness Coaches are prepared to assist persons living with mental illness to link to primary health care and health promotion activities. This role addresses health and wellness needs from a self-management perspective with a focus on helping reduce high risk behaviors and health risk factors such as smoking, poor illness self-management, inadequate diet, and infrequent exercise.
Via Hope Whole Health – Via Hope Texas Mental Health Resource is a new training and technical assistance center for consumers, family members, youth consumers, and professionals. It is funded by a grant from the Department of State Health Services as part of the state’s Mental Health Transformation State incentive Grant. One of Via Hope’s major initiatives is to develop and operate a statewide peer specialist training and certification program, a first for Texas. A peer specialist is an individual who is in recovery from a mental illness who uses his or her lived experience to help others with their recovery. Peer specialists who are used effectively work one on one with consumers or lead support groups; and compliment, but do not replace, the work of licensed professionals.
Vericare Integration of Health and Behavioral Health Initiatives for Skilled Nursing Facilites (SNF) - Psychological and clinical social work services have been introduced to SNF's and, typically, referrals are made at the discretion of SNF staff to address an array of mental health needs of residents. SNF initiatives may involve psychological service integration into physical and occupational therapy. Behavioral health staff actively consult with SNF staff in the development of resident's treatment plans and case conferences and conduct in-service training as well.
Department of State Health Services Money Follows the Person Behavioral Health Pilot (MFP-BH) – The MFP-BH Pilot in Bexar County is designed to help adults with behavioral health disorders leave nursing facilities and live successfully in the community. The Pilot integrates evidence-based mental health and substance abuse services, such as Cognitive Adaptation Training (CAT) and substance abuse counseling, provided through the local mental health authority with existing community-based long term and acute care services and supports provided through the State’s STAR+PLUS Medicaid managed care program.
Department of State Health Services: Texas Demonstration to Maintain Independence and Employment (DMIE) – This is a national study focused on preventing disability among workers. Texas DMIE examines whether working adults with potentially disabling physical and/or behavioral health conditions can avoid becoming disabled and dependent on federal disability benefits if they receive better integrated health, behavioral health and employment supports. Individuals from The Harris County Hospital District (HCHD) were recruited and randomized into intervention (n=904) and control groups (n=712). The control group received services normally available through HCHD. In addition, the intervention group had access to case management and enhanced medical, mental health, substance abuse, prescription, dental and vision benefits (new benefits, co-payment for existing benefits eliminated).
You can see from the not-so-brief overview that we had an infinite variety of models and players involved in these presentations. Next, we will get back into our subcommittees to discuss these models and those we studied in the last meeting. Let me say this is definitely a WORK group experience! If you have comments or information to share, please e-mail me at OllieSeayPhD@austin.rr.com or comment on this blog!
