As a starting place, IBHP funded nine initial demonstration projects: seven based in primary care clinics and two in regional consortia to see what components of integrated care correlate with successful results. The goal was to identify, elevate and accelerate promising practices in integrated behavioral health care throughout the state of California.In Phase II, IBHP awarded 16 grants to primary care clinics and clinic consortia to foster innovative projects that not only further their own integrated care programs, but offer the possibility of becoming a best practice to be replicated by others. We also awarded 11 Learner Grants to enable the participation of key primary care personnel in the training and information exchange generated in our Learning Community and Mentoring Program. In Phase III, we chose to fund specialized projects proposed by six clinics and one clinic consortia to study aspects of integrated care that we thought may advance the field.
Phase I Demonstration Grants
In March, 2007, IBHP launched its demonstration phase of model review and data compilation by awarding one-year grants to select primary care clinics and clinic associations. Grantee organizations were chosen based on their involvement with integrated behavioral care, either through provision of direct services or through their advocacy and policy work. Geographic diversity and diversity of client populations were also considered in the selection, as was the presence of innovative and unique approaches that may benefit other similarly-situated programs. We set out our selection criteria and grant requirements in our application: Integrated Behavioral Health Project Application and Criteria for Demonstration Site Selection.
In addition to being data-gatherers and study sites, the demonstration programs acted as “thought partners” to IBHP, furnishing policies, protocols, strategies; approaches and advice related to establishing and maintaining behavioral health programs within behavioral settings. . IBHP developed recommended treatment approaches, collateral material and assessment tools based on the findings of this demonstration phase. It was hoped that the information collected during this initial phase would be used to accelerate and elevate promising integrated behavioral health practices throughout California by better informing model development
Specific IBHP Objectives
- Identifying and elevating program elements, strategies, and treatment approaches leading to successful integration of mental and physical care;
- Collecting information about integration that can be developed into training materials and tools for other sites;
- Gathering data via standardized instruments to measure client satisfaction, provider satisfaction, client functioning and general program effectiveness;
- Improving outcome measure data collection capacity at the provider level.
- Documenting integrated systems of care between primary care and county mental health providers.
- Reducing the policy barriers to integrating behavioral care.
Phase II Grants
The granting process, criteria and requirements are detailed in the grant application disseminated in June, 2008. A summary of the procedure and grant objectives can be found in the grant overview.
This phase of the IBHP initiative focuses on grant activities in three areas: expanding the learning community activities to include a mentoring component; advocating for policy and system changes to reduce barriers to integration efforts; and fostering innovative projects at the clinic and consortia level to meet specified grant objectives in one of the following seven areas:
- Expanding intra-clinic collaboration between primary care and behavioral service providers;
- Increasing positive treatment outcomes;
- Maximizing client engagement;
- Advancing cross-system collaboration;
- Enhancing the integration of primary care clinic substance abuse programs with primary care and behavioral health services;
- Broadening the provision of medical services for clients with serious mental health problems; and
- Developing a Prevention and Early Intervention (PEI) prototype, suitable for replication at other clinics, and defining a strategy for implementation consistent with the Mental Health Services Act (MHSA) guidelines and local mental health agency MHSA planning activities.
Clinic Eligibility Criteria:
Clinic corporations that provide comprehensive primary care services, including family planning clinics, school-based clinics, and American Indian Health Centers, were eligible to apply.
Clinic corporations also met these criteria:
- Be licensed by the state of California as a community clinic or tribally designated clinic, providing direct medical care to underserved populations;
- Be freestanding
- Be community-based and owned;
- Be nonprofit, 501©(3) or a tribally chartered/sanctioned organization; and
- Provide services regardless of ability to pay.
Consortium Eligibility Criteria:
Eligible consortia must have at least 80% of their membership consisting of community clinics or demonstrate that they have been designated by a network of community clinics to act on their behalf in a management capacity.
Grant applicants were asked to propose a project to broaden or deepen their collaborative work. Those chosen were selected on the basis of their project’s potential to reach its objective, practicality, sustainability, evidence-backed substantiation, relative need, ability to produce quantifiable results, replication potential, innovation, and contribution to the project, population and geographic diversity of the initiative.
Integration Level Survey:
Because IBHP wanted to engage health centers falling all along the spectrum of behavioral care integration – not just those recently embarking on it nor those relatively sophisticated – we asked all grant applications to complete an Integration Level Survey to give us an indication of where they fell on the continuum. This breif checklist encompassed questions about proximity of the behavioral care program, both in terms of time and location, case management, psychiatric consultation, funding and other relevant areas.
Phase III Grants
During the first two phases of work, IBHP has focused primarily on community clinics and building the standards of practice. However, for integration to take hold throughout the health care system, including being adequately reimbursed by both public and private payers, a variety of stakeholders need to be engaged. Therefore, for Phase III, IBHP continuesd its efforts with community clinics, but also expanded its field-building work to include a broader range of stakeholders and targets. Thus, Phase III concentrated on:
- Coalition Building
- Policy and advocacy, targeting specific issues at the local, state and federal levels
- Communications, research and strategic dissemination of evaluation findings, case studies and policy briefs
- Training and TA
- Supporting the network of leaders and continuing a learning community
Key questions that have served as cornerstones in Phase III grant-making include:
- What are best practices associated for client engagement?
- What does a health home, which has fully integrated behavioral health, look like in a community clinic setting?
- What models of collaborative care work best in the community clinic setting?
- What is the business case for integrated behavioral health for community clinics, including the costs and benefits of integration?
- How can primary care clinics and public behavioral health agencies improve collaboration to better serve the needs of patients with the full spectrum of mental health issues?