268081 Community-driven primary and behavioral health care integration: Lessons learned from Heart of the City Health Center

Monday, October 29, 2012

Olivia Lindly, MPH , School of Medicine, Oregon Health & Science University, Portland, OR
Greg Dziadosz, PhD , Durham Clinic, Heart of the City Health Center, Grand Rapids, MI
Kristin Spykerman, LMSW , Durham Clinic, Heart of the City Health Center, Grand Rapids, MI
Julia Fantacone, BA , Community Health Systems - Policy, planning, and evaluation practice area, Altarum Institute, Washington, DC
One in every five U.S. adults had a mental illness in 2010. A subset of this population, adults with serious mental illness have been found to die an average of 25 years younger than the general U.S. population. To remedy this and other disparities associated with fragmented systems of care, the integration of primary and behavioral health care has gained increasing momentum. Still, limited research has assessed how such approaches are collectively planned, implemented, sustained, and spread by local safety net providers.

Formative research was therefore conducted to capture developmental processes and initial experiences associated with the launch of an integrated primary and behavioral health care program for adults with serious mental illness and other chronic conditions by three community-based health care organizations. Research methods included 25 key informant interviews and four focus groups conducted with a purposive sample of top management staff, health professionals, and patients across the three organizations. Qualitative data were collected at two time points and inductively analyzed with NVivo 8 software.

Leadership, organization, education, communication, and collaboration emerged as themes critical to the development of an integrated care system among top management and health professionals. Care team cohesion, patient engagement, and alignment of condition self-management goals between care team members and patients emerged as themes salient to the initial experiences of health professionals and patients. These findings informed the program's operational and clinical transformation to an integrated collaborative system of care currently serving 400 adults with chronic conditions at Heart of the City Health Center.

Learning Areas:
Administration, management, leadership
Chronic disease management and prevention
Program planning
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1) Describe the interorganizational workgroup planning process used to launch this integrated health care program. 2) Compare the key barriers and facilitators to integrated care implementation identified among administrative staff members to those identified among health professionals delivering integrated care during the developmental phase of this program. 3) Define the central components of the integrated care model initially implemented by the integration development care team. 4) Identify common themes that emerged regarding initial experiences of integrated health care received among adult patients with serious mental illness and other chronic conditions during the programís developmental phase. 5) Discuss lessons learned from this programís developmental phase specifically related to the sustainability and subsequent expansion of the program as the Durham Clinic at Heart of the City Health Center.

Keywords: Mental Health Care, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have led and managed numerous formative research and evaluation studies focused on health systems change and transformation over the past four years that have been externally funded by federal and state government entities or internally funded by Altarum Institute.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.