I work in a community health center and a family medicine residency
program in New Hampshire. Along with many in the Collaborative Family
Healthcare Association (CFHA) I have wanted to be able to "group up” and
find ways for those doing collaborative work to get together and share
their successes and barriers. The CFHA has been trying to stimulate
regional efforts through conferences and summits; enlisting interested
stakeholders to meet as part of the annual conference. I have noticed
however that there are many more out there who don’t write about what
they do, they don’t meet at regional summits and they don’t go to
conferences, they just do great things! We all want to avoid isolation
and add to the momentum to cause a "tipping point” effect for
years ago in New Hampshire, a relatively small state known for
conservative politics and primaries, there was a significant effort to
define what mental healthcare reform could look like to bring the state
from its current "D” rating back to its previous "A” rating a few
years ago. I served as co-chair along with the Executive Director of NAMI,
Mike Cohen on a workgroup focused on integrated care. We met for two
years with physicians, consumers, behavioral health practitioners and
administrators to produce a document that reflected our summary and
recommendations about what needed to happen to integrate care. The
results were published and through a meeting with the governor and many
legislators we all learned more about improving our current healthcare
status. The bumper sticker read "Mental Health is part of Overall
Health”. The ball moved a bit forward.
papers are great and there are lots of them. But how do you keep the
ball rolling? Enter the learning community! The terms "learning
collaborative” and "learning community” have been used by many including
the Institute for Healthcare Improvement and the National Council for Community Behavioral Healthcare. Learning communities are more grass roots and open to all interested
parties Our first meeting with thirty interested stakeholders, met for
three hours without a break and created a significant local "buzz”.
that first meeting in October of 2008 we have continued to meet
bi-monthly for the past two years. This year we have reorganized and
are having a fall and spring meeting each with a local guest presenter.
Last fall, Craig Jones, medical director of the Vermont Blueprint for Health was a guest speaker and he talked about the critical importance of his
state’s incorporation of behavioral health professionals in their
health reform pilot projects. Medical (Health) home projects all over
the country are learning the lesson that incorporating behavioral
health is a key component. Following are some key points that may
facilitate creating an Integrated Care Learning Community.
1. Actively engage those individuals who are already moving ahead with some form of integrated care.
Engage as many different ‘world views” as possible. We had CEO’s and
CFO’s of several local mental health centers as well as community
health centers, behavioral health consultants in community health
centers, academic researchers, primary care physicians in private
practice and in community health centers, state administrators from
Health and Human Services, (Nancy Rollins, state deputy commissioner
was the co-leader of this initiative) and substance use administrators
3. Create a mailing list to function as a list serve so members can communicate with each other between meetings.
Keep the initial focus on sharing knowledge and best practices. While
the Antioch NE research project (mentioned below) was an ongoing
project, busy professionals can lose sight of the primary purpose of
this group by creating to much of a "to do” list. This can be a
natural outgrowth later.
Keep the idea of policy advocacy at the forefront. As state
legislators or medical home pilot projects become more interested in
this effort, membership of the learning communities can be a way to
become involved in these more comprehensive efforts.
learning communities are a great way to informally organize. They
could even be seen as state or regional chapters of CFHA to increase
contact between national meetings and try to keep up with the expanding
knowledge in the field. I look forward to hearing more stories about
other efforts to create these around integrated care.
Here are three examples of integration projects happening here in NH that you will likely not have heard about.
Mid-State Health Center located north of Concord in Plymouth NH. Here psychologist Vince
Scalese and physician Fred Kelsey had been working in parallel practices
for 30 years. Through work and over the occasional beer, they often
revisited the idea of "Wouldn’t it be nice if we got together in
practice”. So five years ago, Vince agreed to merge his practice with
Mid-State for which Fred served (and continues to serve) as the Medical
Director. The Electronic Health Record that has been in place since
2003 was tweaked to include templates for behavioral health services.
This was done so patients would have a truly shared record that was
designed for the way the both clinicians documented. The CEO of
Mid-State, Sharon Beaty, worked to break down administrative and
financial barriers for them, built a new building with behavioral health
in the center of the action and together Mid-State is making it
Antioch University New England located in western New Hampshire. Psychologists Jim Fauth and his
colleagues received local funds to provide support in evaluating local
projects in five community health centers in the state. Representatives
from all five heath centers joined the learning community and reported
on the populations on which they were focused and ways in which they
were trying to improve care delivery to those populations. Four of the
five centers have embedded behavioral health services and have
benefited from the efforts to participate together in a joint
Avis Goodwin Community Health Center in Dover, New Hampshire. In partnership with Great Bay Mental Health, leaders of the project worked with Intermountain Health Care to secure a grant that would put psychological and social services
together with medical services. They used protocols and processes that
Intermountain has employed for several years. Sandy Rose, PhD,
psychologist and owner of Great Bay recently shared her research with
the learning community on the use of informed consent forms to be used
in primary care.
is just mention of a few examples. There are many more and the
capacity to follow and advise these projects has been very
stimulating…………but you get the idea. The excitement over finding like
minded folks who were local was a great thing!