Strategies for Successful Client Engagement and Positive Outcomes in a Florida SAMHSA PCBHI Demonstration

This presentation will describe the successes and challenges of implementating the SAMHSA Primary Care Behavioral Health Integration demonstration program in our community; its impact on client outcomes, and strategies for developing and sustaining integrated systems of care. Topics will include practical lessons for successful implementation in the areas of training, medical staff, billing, and marketplace enrollment.

Background:In spite of high prevalence for mental health disorders, a fraction of those affected receive adequate or appropriate treatment (SAMHSA, 2008).  Because many mental illnesses can be prevented, early screening, detection, and treatment are key factors in reducing costs and increasing community wellness.

 In 2011, two Federally Qualified Health Centers (FQHCs) in Miami received funding from SAMHSA/ HRSA to pilot test an integrated care model incorporating behavioral health screening and services into existing prima ry care locations.  Compared to Miami-Dade, census data reveals these communities are overwhelmingly minority (Black, Haitian, and Cuban), earn roughly 50% of the annual income, have more than double the poverty rate, and nearly double the unemployment rate. These factors, coupled with the cultural stigma around mental health, make self-referrals to behavioral health services nearly non-existent in these communities - offering an opportunity to test "integrated care" strategies to engage people in services.

Results: More than 2000 persons have been screened for behavioral health issues, more than 1,000 have gone on to further assessments, and hundreds have received outpatient behavioral health services, and supplementary peer services such as stress reduction sessions.  Reassessments after 180 days indicate dramatic reductions in mental health symptoms, substance use, and nights spent in institutions.