The integration of primary and behavioral healthcare is crucial for improving the physical and mental well-being of individuals with mental illness. This article explores organizational change tools, specifically focusing on the Integrated Treatment Tool developed by Shawnee Mental Health Center and the Center for Evidence-Based Practices at Case Western Reserve University, that facilitate this complex process. This tool guides the integration of primary care into behavioral health settings, leading to better health outcomes for patients.
Implementing Integrated Care: A Practical Guide
The alarming statistic that individuals with severe mental illness often die 25 years earlier than the general population highlights the urgent need for integrated healthcare. Chronic medical conditions, largely preventable and treatable, contribute significantly to this premature mortality. The Integrated Treatment Tool, a 30-item planning and evaluation resource, addresses this issue by guiding organizational change toward integrated care. Developed with support from the Substance Abuse and Mental Health Services Administration (SAMHSA), this tool facilitates the development and assessment of primary care services within mental health settings.
The Integrated Treatment Tool: A Catalyst for Change
Funded by SAMHSA’s Primary and Behavioral Health Care Integration (PBHCI) Program, the Integrated Treatment Tool provides a structured framework for organizations seeking to integrate primary and behavioral healthcare. This framework encompasses 13 organizational components, 10 treatment components, and 7 care coordination and management components. The tool draws upon evidence-based practices like Integrated Dual Disorder Treatment (IDDT) and Supported Employment/Individual Placement and Support (SE/IPS), as well as national standards like those of the National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH).
Utilizing the Tool for Continuous Improvement
The Integrated Treatment Tool is not a fidelity scale for an established evidence-based practice, but rather a dynamic organizational change tool. It guides implementation committees and teams through a four-stage process:
- Initial Needs and Baseline Assessment: Evaluating current resources and identifying areas for improvement.
- Progress Review: Monitoring implementation progress, recognizing facilitators and barriers.
- Planning Next Steps: Developing strategies to address challenges and enhance integration.
- Action Plan Revision: Continuously refining the implementation plan for ongoing quality improvement.
Achieving Tangible Results with Integrated Care
Shawnee Mental Health Center, utilizing the Integrated Treatment Tool, has successfully established integrated primary care facilities in three Ohio counties. Initial results indicate positive impacts on consumer health, including weight loss, smoking cessation, lower blood pressure, and improved hemoglobin A1c levels. Prior to this initiative, over 40% of Shawnee’s clients lacked a primary care physician, often relying on emergency rooms for medical care.
A Phased Approach to Sustainable Change
Implementing integrated care can be a complex undertaking. The Integrated Treatment Tool promotes a stage-wise approach, allowing organizations to set achievable goals and gradually build capacity. This flexible framework accommodates various models of integration, enabling organizations to tailor their approach to specific needs and resources. Even without fully embedding primary care within behavioral health facilities, the tool facilitates incremental progress toward integration.
Technology Transfer and Dissemination
The Center for Evidence-Based Practices is committed to disseminating the Integrated Treatment Tool nationally, recognizing its potential to transform healthcare delivery. This tool provides practical guidance for implementing integrated care, addressing the “how-to” aspects often overlooked in theoretical discussions. The Center’s multidisciplinary team of experts offers consultation, training, and evaluation services to support organizations in this process.
Conclusion: Transforming Healthcare Through Integration
The Integrated Treatment Tool offers a valuable resource for organizations striving to improve the health and well-being of individuals with mental illness. By facilitating a structured, phased approach to integrating primary and behavioral healthcare, this tool empowers organizations to achieve meaningful and sustainable change. The positive outcomes observed at Shawnee Mental Health Center demonstrate the potential of this approach to transform healthcare delivery and address the significant health disparities faced by individuals with mental illness. The ongoing development and dissemination of this tool promise to further advance integrated care nationwide.
