Phase I – Demonstration Grants
Demonstration clinics, in concert with IBHP consultants, gathered data using a combination of customized and standardized instruments to measure outcomes, including:
- Client Satisfaction Survey. At the beginning of service (baseline) and at six visit intervals, behavioral health clients rate their general satisfaction with the services and the model, as well as their comfort level with treatment and setting.
- Primary Care Provider Survey (conducted on-line). Primary care providers complete separate surveys regarding quality of care and model satisfaction.
- Behavioral Consultant Satisfaction Survey (conducted on-line). Behavioral consultants.
- PHQ-9. Behavioral health clients respond to questions assessing their level of depression upon referral to behavioral care and at six-visit intervals thereafter.
- Duke Health Profile. At six-visit intervals, behavioral health clients respond to questions assessing the overall quality of their lives and functioning.
For more information about these and other assessment instruments, go to the Evaluation section of our website.
Clinics and IBHP consultants also addressed various aspects of integrated models by examining:
- rates of client engagement, retention and utilization of services;
- rates of client follow-through with behavioral health treatment referrals;
- cultural competence levels within the organizational infrastructure and services provided;
- level of integration within clinic, e.g., communication; physical proximity of services; temporal proximity in the delivery of services;
and availability of behavioral health expertise;
- total and per-client costs of integrated behavioral care and cost-savings, if any, realized as a result of the behavioral care program.
- the role of clinic associations in advocating for and supporting integrated behavioral health programs; and
- telemedicine as a resource for psychiatric consultations.
This information will be used to better inform other clinics contemplating or already instituting integrated care. IBHP will describe alternative treatment approaches and assessment tools based on the findings of this demonstration phase. In addition to being data-gatherers and study sites, the demonstration programs will act as “thought partners” to IBHP, furnishing policies, protocols, strategies; approaches and advice related to establishing and maintaining behavioral health programs within behavioral settings.
Gary Bess and Associates, who collected and analyzed outcome data from our grantee primary care clinics’ integrated behavioral health programs, prepared a presentation of preliminary findings. Among them:
- The mean PHQ-9 depression score for patients decreased from baseline to most recent follow-up assessment at statistically significant levels.
- High levels of satisfaction with services, model, treatment, and setting (mean scores of above 4.50 on the five-point scale) were experienced by clinic patients.
- Patients indicated they were more likely to follow through on referrals to specialty mental health clinics after a course of behavioral treatment at primary care clinics.
- Anxiety levels decreased significantly in patients received integrated behavioral health treatment, especially in white females.
The final report of descriptive data, compiled from outcome data involving over 5,000 patients and staff at nine California primary care clinics, is contained in Phase I Summative Report, released in June, 2009. Among the findings of the report:
- Point of entry PHQ-9 scores (for depression) of patients with chronic diseases indicated that approximately 80% were likely candidates for depression treatment; for one-third of this population, treatment was definitely indicated.
- There were statisfically significant improvements in physical health, mental health and general health after behavioral treatment was initiated at the clinic, as measured by the Duke Health Profile and PHQ-9.
- While behavioral staff reported their own level of behavioral care exptertise and services as high, primary care providers gave them “moderate” ratings. Primary care providers also reported a lower level of integration between physical and behavioral health at the clinic than did behavioral health professionals.
A comprehensive case studies report, detailing the results and challenges of IBHP-funded projects undertaken by individual clinics, was released by Desert Vista Consulting in 2010.
For phase II, we tried to select projects that encompass varied facets of integrated care and met the seven objectives specified above. Among those chosen were projects that focus on integration of substance abuse programs; development of behavioral registries and tracking systems; advancement of cross-systems collaboration; introduction of systematic behavioral screening and establishment of clear treatment pathways; enhanced intra-disciplinary case-conferencing; better coordination of patients with co-occurring behavioral and medical disorders; and improved patient outcomes in targeted areas. To maximize cross-fertilization of ideas and approaches, we clustered grantees with similar or intersecting objectives within our Learning Community.
For Phase III, we tried to develop, in concert with our grantees, projects that would advance the concept of the person-centered health home. For a brief description of Phase III projects, including measures used, see IBHP Phase III Project Description.
For Powerpoint descriptions of individual grantee Phase III projects, click the organization’s name below: