The Philadelphia Integrative Behavioral Health Initiative

Emerson EvansSAMHSA MAI-TCE Project Coordinator

City of Philadelphia Department of Public HealthAIDS Activities Coordinating Office

December 12th, 2013

Philadelphia Integrative Behavioral Health Initiative (PIBHI)

• Supported by Minority AIDS Initiative, who is supported by Substance Abuse Mental Health Services Administration (SAMSHA)

• Bolsters goals and objectives of the National HIV/AIDS Strategy

• Aims to improve HIV-related health outcomes

• Part of the “12 Cities Project” (ECHPP) which funds HIV/AIDS services in the most heavily impacted areas throughout the country

DHHS/SAMSHA

PDPH/AACO

PIBHI

A Population Based Behavioral Health Intervention

Program Goals• Integrated provision of behavioral and primary healthcare• Reduce

- HIV Incidence- Impact of psychosocial cormbidities - HIV related health disparities

• Improve- Quality of life- Adherence- Viral load and CD4 measures- Retention in care- Risk reduction

Behavioral Health Consulting (BHC) Model at a Glance

• Goal is to promote integration of behavioral health services within primary care team• Delivers high-volume, problem-focused care delivered in brief sessions• Treats any behaviorally-based problem• Has on-demand availability, fluid schedule• Provides immediate feedback to PCP on patient behavioral health difficulties• Looks to achieve key changes supporting HIV patients in large numbers• Goal is to improve PCP management of behavioral issues• Aims to improve the care milieu in HIV primary care

Behavioral Health Consultant Roles

• Consultation to medical provider• Provide behavioral health integrated into an

HIV clinical setting• Screen, triage, refer, and provide patient

focused behavioral health intervention

The Philadelphia Integrative Behavioral Health InitiativeOrganizational Structure

Project Administration – AACO Partner APartner C

Behavioral Health

Consultants

Certified Peer

Recovery Coaches

Partner B

Patient(s)

HIV Specialty Clinics (9) Integrated Provision of HIV Primary Care and Behavioral

Health Services

External Services

Peer recovery coaching

Workforce development,

capacity building

Certified Peer Specialist Roles

• Implementation of client centered action plan aimed towards attainment of goals and autonomy

• Assist with linkage to resources and community engagement

Mental Health Clinical Presentations

Mental Health Impression % of BHC patient population (Frequency)

Depression 42.1 % (584)

Anxiety 10.5% (146)

Bipolar 3.5% (48)

Psychopathy, Sociopathy <0% (1)

Psychotic Symptoms 1.7% (23)

Other 26.5% (368)

None 15.6% (216)

Total 100% (1387)

Predominant Diagnostic Mental Health Impression

***This table contains unduplicated BHC patients from clinic start date up until March 31st, 2013***

Substance Abuse Clinical Presentations

Substance Percentage (Frequency)Marijuana 4.5% (62)

Alcohol 4.4% (61)Cocaine 4.75% (66)Heroin <1% (9)Benzos <1% (2)Meth <1% (3)

Other Opiates (pain killers) <1 % (3)Other substances 3.6% (50)

Multiple substances 3.5 % (48)None 77.4% (1074)Total 100% (1387)

Diagnostic Substance Abuse Impression

***This table contains unduplicated BHC patients from clinic start date up until March 31st, 2013***

179

898

35

275

Substance Abuse and Mental Health Comorbidities

-

+

- + Mental Health

Substance Abuse

A Population Based Behavioral Health Intervention

BHC Clinic PenetrationClinic BHC Start Date # Patients # BHC Patients % Penetration

Clinic A June 2012 1039 432 41.6%

Clinic B May 2012 731 316 43.2%

Clinic C June 2012 731 370 50.6%

Clinic D September 2012 948 333 35.1%

Clinic E August 2012 1080 270 25.0%

Clinic F May 2012 1677 580 34.5%

Total 6206 1798 28.97%

*Data as of 10/31/13

Progress Continued…

Screened 2301 (37.1%)

2nd Visits 982 (42.7%)

3+ Visits 581 (59.1%)

Philadelphia Integrative Behavioral Health Initiative Totals Oct 2012-Oct 2013

Lessons Learned• It is practical and feasible to provide a population based behavioral

intervention• It is difficult to integrate behavioral health into a medical setting that

itself is poorly integrated• Medical providers need updated training on psychopharmacology to

increase competency levels in providing services• Collaboration among local, state, and federal institutions to eliminate

barriers for reimbursement for innovate mental health interventions• The use of peers can be helpful in reducing resistance to behavioral

health services and support retention efforts• The HIV positive population provides an appropriate outlet to

integrate behavioral health and HIV care

Next Steps• Grant period ends September 2014• Evaluation efforts have began

- CAREWare- Collaboration with CBH- CESD Scores

• Effects of the Affordable Care Act and it’s affect on mental health• Program sustainability

- Funding- Funding Sources- Program structure- Institutional buy in