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Trilogy Behavioral HealthcareChicago, IL
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
Agenda
Who is Trilogy?
Defining the Need
The Integrated Healthcare Model
Program Outcomes
Challenges
Lessons Learned
Future Directions
Who is Trilogy? Trilogy’s mission is to assist people in their recovery from serious mental illness by helping them discover and reclaim their own capabilities
and life direction.
Who Trilogy Serves
950 clients currently
When coming to Trilogy:48% of clients have co-occurring substance use
issues75% of clients do not have a psychiatrist40% of clients do not have a primary care physician18% of clients are homeless
Average # of Primary Care encounters annually: 7Average # of Psychiatry encounters annually: 6Average # of Medications: 8
THE TRILOGY TEAM
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
The Integrated Healthcare Model
CULTURE
OUTCOMES
PEER STAFF
PRIMARY
HEALTH
TECHNOLOGY
WELLNESS
SERVICES
PARTNERSHIPS
CONSUMERS
LEADERSHIP
EDUCATION
BEHAVIORAL
HEALTH
SMOKING CESSATIONSUSTAINABILITY
NURSING
OCCUPATIONAL
THERAPY
WORKFORCE
Well-coordinated CareQuality CarePerson-CenteredShared MissionCreativityFlexibility
CULTURE
Behavioral
Health
Primary Care
Co-locationLayout of siteWorkforceCare coordination
WELLNESS
SERVICES
ExerciseNutritionIllness ManagementSelf-careEducation
PARTNERSHIPS
Heartland Health CentersRush University College of Nursing
Chicago House
SUSTAINABILITY
FQHC BillingUtilizing StudentsMaximizing reimbursement value
WORKFORCE
DEVELOPMENT
Academic Partnership
The Center for Integrated Healthcare Education
Peer Ambassadors
TECHNOLOGY
Electronic Medical Records
Sharing Information
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/coachingRecovery resource connectingFacilitating & Leading GroupsBuilding Community
PEER SPECIALISTS
Consumer Advisory CouncilWRAP (Wellness Recovery Action Plan)WHAM (Whole Health Action Management)Trauma-Informed Care
CONSUMERS
Wellness FairsFamily NightsWorld AIDS DaySuicide Prevention WeekBBQsLandlord Meet & Greet
COMMUNITY OUTREACH
Practice ApartmentOT Assessments:
Includes Hygiene, Cooking, Safety, Cleaning & Leisure Activities
Adaptive DevicesInvolvement in Care Team
OCCUPATIONAL
THERAPY
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"
SMOKING CESSATION
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
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
EDUCATION
MANAGING WITH
OUTCOMES
Data CollectionMonitoringEvaluationDashboards & Reporting
Co-Morbidities and Disparities
Biomarker or Disease
Our Clients Nationally, individuals with SMI
Overall Population
BMI (n=486) Obese: 50% 60% of patients with bipolar disorder, 70% of patients with schizophrenia, & 55% of patients with depression
Obese: 35.7%
Diabetes (n=776)
15.7% 15%-18% of individuals with schizophrenia
11.3%
Tobacco Use (n=748)
54% 75% 18.1%
Blood Pressure (n=529)
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%)
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)
National Outcome Measures Results
National Outcome Measures (n=440) Outcome ImprovedHealthy 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%
Consumer Smoking Status
2012 2014
54%46%38%
62%
Challenges
Need to continually redesign workflows
Need for staff training
Stigma
Inadequate space
Establishing efficient documentation process
Integrating technology
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
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
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
Questions?
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