Trilogy Behavioral Healthcare

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The Evolution of Integrated Healthcare at a
Behavioral Health Organization in an Urban
Community

• Sara Gotheridge, MD Alice Geis, DNP, APN
• Chief Medical Officer Director of Integrated
  Healthcare

• Mary Colleran, MSW John Mayes, LCSW, CADC
• Chief Operations Officer President/CEO

• Trilogy Behavioral Healthcare
• Chicago, IL

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Agenda

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

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Who is Trilogy?

• Trilogys mission is to assist people in
  their recovery from serious mental illness by
  helping them discover and reclaim their own
  capabilities and life direction.

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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

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THE TRILOGY TEAM
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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

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

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

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Primary Care
Behavioral Health

• Co-location
• Layout of site
• Workforce
• Care coordination

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WELLNESS SERVICES

• Exercise
• Nutrition
• Illness Management
• Self-care
• Education

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PARTNERSHIPS

• Heartland Health Centers
• Rush University College of Nursing
• Chicago House

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SUSTAINABILITY

• FQHC Billing
• Utilizing Students
• Maximizing reimbursement value

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WORKFORCE DEVELOPMENT

• Academic Partnership
• The Center for Integrated Healthcare Education
• Peer Ambassadors

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TECHNOLOGY

• Electronic Medical Records
• Sharing Information

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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

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CONSUMERS

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

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COMMUNITY OUTREACH

• Wellness Fairs
• Family Nights
• World AIDS Day
• Suicide Prevention Week
• BBQs
• Landlord Meet Greet

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OCCUPATIONAL THERAPY

• Practice Apartment
• OT Assessments
• Includes Hygiene, Cooking, Safety, Cleaning
  Leisure Activities
• Adaptive Devices
• Involvement in Care Team

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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"

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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

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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

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MANAGING WITH OUTCOMES

• Data Collection
• Monitoring
• Evaluation
• Dashboards Reporting

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Co-Morbidities and Disparities
Biomarker or Disease Our Clients Nationally, individuals with SMI Overall Population
BMI (n486) Obese 50 60 of patients with bipolar disorder, 70 of patients with schizophrenia, 55 of patients with depression Obese 35.7
Diabetes (n776) 15.7 15-18 of individuals with schizophrenia 11.3
Tobacco Use (n748) 54 75 18.1
Blood Pressure (n529) 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)
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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 HgBA1C (diabetes
  management)
• 58 have improved cholesterol
• 18 have improved blood pressure
• 36 have improved Breath CO level (smoking
  cessation)

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National Outcome Measures Results
National Outcome Measures (n440) Outcome Improved
Healthy Overall 19
Functioning in Everyday Life 62
No Serious Psychological Distress 14
Use of Illegal Substances 8
Use of Tobacco Products 4
Binge Drinking 6
Had a Stable Place to Live 14
Attending school regularly and/or employed 13
Involvement with Criminal Justice System 2
Socially Connected 47
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Consumer Smoking Status

• 2012 2014

38
54
46
62
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Challenges

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

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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

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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

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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

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Questions?