El Paso Behavioral Health Consortium Integration Leadership Council Action Plan Goal 1: ILC partners will increase availability of evidence-based behavioral health community education and training programs for primary care providers (physicians, nurses, pharmacists, etc.) to improve behavioral health and substance use screenings and care coordination. Objective 1.1: Increase knowledge of primary care physicians and nurse practitioners regarding integration of behavioral health and substance use prevention/intervention in primary care. Work with Texas Tech Department of Psychiatry to develop a free CME programming focusing on integration of screening and brief intervention for substance use and behavioral health in primary care. Recruit attendance from the El Paso Medical Association. Focus on attendance of primary care physicians. Use professional networks to recruit nurse practitioners to attend training. Timeline: Conduct one training each year. Value Added: Primary care providers serve essential gatekeeping and screening roles with large numbers of high-risk patients. Their increased awareness of current best practices in detection and care coordination of behavioral health and substance use conditions is a necessary precondition to successful care integration. Objective 1.2: Increase the skills of nursing staff and medical assistants to apply behavioral health and substance use screening instruments and care coordination effectively in busy primary care settings. Sponsor a free continuing education event for nurses and medical assistants that focuses on the logistics of integrating evidence-based screening measures and referral practices in primary care practice settings. Invite nurse speakers from thriving integrated care practices in communities with similar health systems. Work through the local nurses association, employers, and universities to increase attendance at the event. Timeline: Conduct one training each year. Value Added: Integration of behavioral health and substance use care in primary care settings is likely to be more successful if front-line staff are well acquainted with screening and referral models that are easily incorporated into their existing workloads. Objective 1.3: Work with the Paso del Norte Health Information Exchange (PHIX) to pursue universal online screening measures that could be made available to participating agencies and integrated into patient records. Page 1 of 6
Evaluate available screening instruments based on psychometric properties, existing patterns of preference and use in the region, and cost. Work with PHIX to acquire the necessary software to make screening measures broadly available. Use the educational opportunities outlined in Objectives 1.1 and 1.2 to disseminate information about screening measures once they are available. Timeline: Implement online screening availability by October of 2019. Value Added: Use of a common, valid screening measure between providers will permit tracking of symptomatology over time and provide a context for universal understanding of screening results. Embedding that measure in the Health Information Exchange will make it easily accessible to providers, enhance the likelihood of adoption, and increase continuity of care. Goal 2. ILC partners will develop robust patient navigation systems in the region to promote continuity of behavioral health care. Objective 2.1: Assess regional culture around active follow-up and handoff of clients. Inventory available patient navigation systems and resources in the community. Survey consumers of mental health services to better understand needs related to continuity of care. Timeline: Complete these strategies by August 31, 2019 Value Added: Patient navigation includes an array of activities and is often called by different names. An inventory of existing practices and needs in the region will be helpful with strategic planning efforts. Objective 2.2: Review existing models of patient navigation in mental health. Conduct a literature review of existing models. Identify models of navigation that show evidence of effectiveness and relevance to the region. Invite experts in patient navigation to share their experiences with building navigation systems. Timeline: Complete these strategies by August 31, 2019 Value Added: Navigation models vary on dimensions including who performs navigation services, who employs navigators, what services are performed, and how those services are performed. Information on different models and their outcomes will be helpful in planning to implement future navigation efforts. Objective 2.3: Implement navigation systems to promote continuity of behavioral health care. Disseminate an interactive behavioral health and recovery resource guide and provide training in its use. Pursue collaboration with the PHIX to facilitate and document patient navigation services. Page 2 of 6
Implement pilot navigation programs at ILC partner organizations. Explore cross-credentialing of agency navigators to enhance collaboration. Timeline: Complete these strategies by August 31, 2020. Value Added: Navigation systems have been shown to decrease emergency room visits, increase patient satisfaction, decrease no-show rates for care, and decrease health disparities for the most vulnerable consumers of services. Goal 3. ILC partners will support the identification and implementation of best practice substance use prevention and intervention programs as informed by Recovery Oriented System of Care (ROSC) members. Objective 3.1: Adopt a common vision for an integrated recovery-oriented system of care. Convene a group of local leaders to inform a set of recovery-oriented principles. Survey ROSC and ILC members to inform a set of recovery-oriented principles. Develop a guide or checklist of recovery-oriented principles for the region. Engage local organizations to administer a self-survey for organizational recoveryorientation. Convene regional organizations, along with ROSC and ILC members to discuss larger recovery-oriented system and principles. Include training, planning and implementation of or for peer-based recovery systems in provider organizations and agencies. Timeline: Implement these strategies by September of 2020 Value Added: ILC and ROSC members support the identification and implementation of best practices, but have not yet articulated a common vision. The process of developing a set of recovery-oriented principles serves to set a foundation for improving health by focusing on a person-centered, family-oriented, system of care co-developed with ILC and ROSC members. Objective 3.2: Increase the core capacity of the ILC and ROSC for coordination and collaboration towards an integrated recovery-oriented system. Develop and adopt a joint statement between ILC and ROSC partners. Create a comprehensive inventory of all surrounding councils involved in strategic planning related to recovery, including international and surrounding cities. Map common goals and agendas across councils. Develop a policy memo and advocate to support recovery-oriented care and reimbursement. Timeline: Implement these strategies by September of 2020 Value Added: Increasing the core capacity of the ILC and the ROSC for coordination and collaboration will support a comprehensive understanding of common and interrelated goals and challenges. The process of adopting a joint statement and creation of lists and inventories of goals and agendas will allow ILC and ROSC members to identify and act upon opportunities to unify and strengthen efforts for the promotion of policies and best practices. Page 3 of 6
Objective 3.3: Facilitate the implementation of an integrated recovery-oriented system of care. Assess use of patient outcome and experience measures and sharing of outcomes across providers. Create a compendium of evidence-based models of integrated care for behavioral health and substance use disorders and share among partners. Provide education to primary care partners, insurance groups, legislative officials, and other stakeholders, to promote understanding and investment in the integrated MH and SUD model of recovery-oriented care. Increase representation of primary care partners, insurance groups, legislative officials, and other stakeholders at meetings about integrated recovery-oriented care. Timeline: Implement these strategies by 2020. Value Added: The documentation of best practices will provide the requisite understanding of evidenced based models among key decision makers, and can be used to help shape policies around implementation and reimbursement. The strategies will result in outcomes that will ultimately aid partners in adopting a recovery oriented system of care. Goal 4: ILC partners will identify and implement evidence-based models for intermediate intensity care for serious mental illness and substance use disorders. Objective 4.1: Conduct research to identify evidence-based models appropriate for use in the Paso del Norte region for intermediate care of serious mental illness and substance use disorders. Define the continuum of intermediate intensity care, including partial hospitalization programs (PHP) and intensive outpatient (IOP) treatment. Survey local providers to determine current capacity, including mental health and substance use disorders addressed, geographic distribution, and accessibility. Research evidence-based models that could increase access to high-quality intermediate intensity care in the region. Timeline: Identify appropriate models by March 30, 2019. Value Added: Multiple PHP and IOP programs exist in the region, however opportunities remain to improve accessibility to specialty care for some conditions and accessibility by uninsured or underinsured individuals. Community input is vital to further improve the continuum of care for serious mental illness and substance use disorders in the region. Objective 4.2: Work with local providers to introduce accessible, evidence-based services that increase coverage of serious mental illnesses and substance use disorders along the continuum of care. Identify and pursue grant funding opportunities for relevant models of care. Convene key leaders and decision makers for regional provider organizations to discuss service needs and potential solutions. Pursue community-driven, sustainable models for these services, in collaboration with the local business community and other stakeholders. Page 4 of 6
Timeline: Introduce targeted changes to intermediate intensity care programs by December 31, 2019. Value Added: Enhancement of options along the continuum of care for serious mental illness and substance use disorders is likely to increase access to care and reduce overreliance on emergency and residential care in cases that can be successfully addressed with an appropriate level of care intensity. Goal 5. ILC partners will collaborate with regional employers and educational institutions to introduce and enhance programs for students that will lead to reimbursable credentials in mental health occupations (e.g., LPC, LMS, LCSW, Licensed Clinical Psychologist, Psych NP, etc.). Objective 5.1: Obtain data that will inform decision making around supply and demand for various mental health professionals. Review data collected by Emergence Health Network regarding perceived workforce needs. Collect data from regional institutions of higher education regarding annual degree conferral in mental health professions. Collect data on the proportion of mental health professionals trained in the region who stay to practice here, and what factors influence that decision Timeline: Gather data by April 30, 2019 Value Added: Although there is a consensus among providers that the region is underserved by mental health professionals, limited data have been compiled in an comprehensive, actionable format. Access to comprehensive, current data will support strategic planning for workforce development. Objective 5.2: Enhance supervision opportunities for mental health professionals-in-training in the region. Increase the number of LPC supervisors in the region, with a focus on those who work for major employers. Increase the number of LCSW supervisors in the region, with a focus on those who work for major employers. Increase the number of Psychology postdoctoral placements in the region Increase the number of GME slots for psychiatrists in the region. Timeline: Achieve significant increases by August 31, 2020. Value Added: After completion of didactic training in most behavioral health disciplines, graduates must complete a significant number of supervised practice hours before becoming eligible for independent licensure. In a number of fields, insufficient opportunities for that experience leads graduates to delay or abandon licensure efforts, or leave the region to complete training elsewhere. Objective 5.3: Work with local educational institutions to introduce new programs that would support the workforce needs of the region. Page 5 of 6
Pursue development of a psychiatric nurse practitioner program in El Paso. Pursue development of graduate training in applied behavior analysis that would support eligibility for the credential of Board Certified Behavior Analyst. Pursue development of a training program for School Psychologists. Timeline: Develop at least two new programs by August 31, 2020. Value Added: Development of relevant training programs in the region will reduce reliance on recruitment from other regions, provide opportunities to aspiring local professionals, and enhance the ability of local providers to offer vital services. Page 6 of 6