Hogg Foundation for Mental Health

Texas with Grantee Selection, Integrated Health Care Initiative Shifts into High Gear

June 1, 2006

Five organizations have been selected to spearhead the Hogg Foundation for Mental Health's Integrated Health Care Initiative grant program. The grantees, announced in April, will receive more than $2.6 million over three years to promote the effective identification and treatment of mental health problems in primary care settings.

The foundation will provide the following grant funding over the three-year initiative:
• Parkland Health and Hospital System Dallas – $576,634
• People's Community Clinic Austin – $275,255
• Project Vida Health Center El Paso – $373,104
• Texas Children's Pediatric Associates Houston – $306,570
• Valley Primary Care Network Harlingen – $1,138,184

The five organizations funded through this initiative will adopt the collaborative care model and address barriers to implementation they encounter. Collaborative care is an integrated health care approach in which primary care and mental health providers partner to manage the treatment of persons with mental health problems in the primary care or pediatric setting. Two decades of research have demonstrated that the collaborative care model improves primary care patients' mental health outcomes with a minimal investment of resources.

"Primary care organizations are typically the first-line providers of mental health care, but most clinicians lack adequate time and training to detect and treat these issues appropriately," said Executive Director Dr. King Davis. "The collaborative care model gives primary care organizations tools to manage mental health problems effectively."

Collaborative Care Model

In the collaborative care model, a mental health care manager and a consulting psychiatrist are integrated into the primary care or pediatric setting.

As trained mental health professionals or paraprofessionals, care managers are responsible for tracking patients with identified mental health needs, educating them about their mental health problems, and monitoring their response to treatment. Care managers ensure that patients do not "slip through the cracks."

The consulting psychiatrist reviews patients who are not responding to treatment and provides treatment recommendations to the care manager, treating physician, and patient. In the short term, primary care physicians receive the expert input they need to manage mental health problems effectively. Over time, physicians become increasingly comfortable treating these problems without assistance.

"Rigorous research has shown that this model has a significant impact on patients' mental health outcomes with a minimal investment of resources," said Davis. "For those reasons, the foundation decided to invest in promoting this model in Texas communities."

Selecting the Grantees

"The response to our IHC Initiative Request for Proposals was very strong," said IHC Project Director Dr. Laurie Alexander. "We were pleased to see the widespread interest in the healthcare community in integrating mental health services into their practice."

The five grantee organizations were selected through a competitive proposal review process. Foundation staff and a national panel of collaborative care experts evaluated applicants' proposals for implementing the collaborative care model and addressing barriers that arise in the process.

"The five grantee organizations clearly demonstrated their commitment and readiness to adopt the model, as well as their understanding of the types of problems they are likely to encounter along the way," said Alexander. "And the diversity of the grantees selected – in terms of organization size, location, and populations served – bodes well for our ability to use lessons learned from this initiative to promote integrated health care elsewhere in the state," she concluded.

More information about the grant initiative, the collaborative care model, and other integrated health care resources is available on the foundation's website.

IHC GRANT PROGRAM

The five grantee organizations will work closely with the foundation and various expert consultants throughout the three-year period as they implement the collaborative care model and address the barriers that arise along the way. The foundation will provide grantees with a variety of resources and technical assistance to help them achieve their goals.

Collaborative Care Training

While most of the grantee organizations have experience with integrated health care in some form, they are all new to collaborative care. To support their adoption of the model, the foundation has contracted with Dr. Jurgen Ünutzer, Chief of Psychiatry at the University of Washington Medical School, and his University of Washington colleagues to provide training and consultation throughout the grant period.

Dr. Ünutzer and his colleagues have over 20 years of experience with implementing and researching collaborative care, including the highly successful IMPACT (Improving Mood–Promoting Access to Collaborative Treatment) Study. Dr. Ünutzer's group provides collaborative care training to organizations around the country.

Program Evaluation

With the grant program's focus on implementation issues, an evaluation of the process that grantees go through in implementing collaborative care and identifying and addressing barriers is essential to the initiative's success. The evaluation's findings will also shed light on patient outcomes, staff satisfaction with the model, and cost-effectiveness.

The foundation has contracted with Dr. Richard Frank, Margaret T. Morris Professor of Health Economics at Harvard University, to conduct the evaluation. Dr. Frank will partner with Dr. Howard Goldman, Director of Mental Health Policy Studies at the University of Maryland School of Medicine, and Ms. Brenda Coleman-Beattie, a Texas behavioral healthcare management consultant, for the program evaluation. The evaluation team has extensive experience in mental health services research.

The team will conduct a process and outcome evaluation of the grant program. Taking a formative approach, the team will use the evaluation results to provide feedback to both the grantees and the foundation throughout the grant period.

Learning Community

Foundation staff and the grantees' project teams will come together regularly throughout the grant period – both in person and through teleconferences – to discuss success and challenges encountered. Through these regular points of connection, the foundation and grantees will create a learning community.

"We hope that both grantees and the foundation will benefit greatly from these learning opportunities," said Dr. Laurie Alexander, IHC Project Director. "The learning community approach will also help us gather information for dissemination to other foundations, primary care providers, mental health providers, and other stakeholders in integrated health care."

The IHC grant program will officially get underway with a kick-off meeting in Austin on June 28. The five grantees' project teams will meet with foundation staff and discuss partnership methods for the initiative. The program's collaborative care trainers and program evaluation team will also be in attendance.

FUTURE STEPS

The foundation is aware that its grant program can only go so far in promoting integrated health care across the state. The grant program is just one element of the foundation's larger IHC Initiative, whose purpose is to clear the barriers to providing integrated health care so it can become standard practice in Texas primary care settings.

Policy Work Group

This summer, the foundation will launch a policy work group on integrated health care. Associate Director for Mental Health Policy and Law Dr. Lynda Frost will lead the work group, which will consist of state experts in mental health and health care policy.

"The work group will focus on identifying and formulating solutions for the policy barriers that interfere with health providers' ability to offer integrated health care," said Frost. "We will bring together advocates and policymakers from around the state to develop policy guidelines to make integrated health care a workable option for Texas organizations."

"There is no easy fix for some of the barriers, such as reimbursement for consultation," said Frost. "However, the foundation is committed to working with policymakers to identify realistic options for addressing these problems."

Collaborative Care Training

The foundation has received numerous requests from organizations to make training in the collaborative care model available to organizations that were not funded.

The foundation is currently looking into ways to make such training available to primary care organizations around the state.

"We are talking with Dr. Ünutzer and his colleagues at the University of Washington about ways to institutionalize the training they will provide our grantees," said Dr. Laurie Alexander, IHC Project Director. "We recognize that we must find a way to make the training available on a larger scale if we hope to promote collaborative care around the state."

Future Funding

The foundation is also looking into funding a second wave of integrated health care grantees once the current group is underway.

"We hope to make more funding available to organizations committed to adopting collaborative care," said Executive Director Dr. King Davis. "After our current grantees are up and running, we will be in a good position to understand how to use their experiences in getting started to inform our work with the second group."

Looking Ahead

As the foundation moves forward with the Integrated Health Care Initiative grant program and related projects, program staff will continue looking for ways to deepen the foundation's work in the area.

"The Hogg Foundation is invested in integrated health care for the long term," said Davis. "This is not just a three-year grant initiative for us. We are committed to making effective integrated health care an everyday reality in Texas."

Parkland Hospital and Health System
Parkland Hospital and Health System in Dallas received a grant of $576,634 over three years to implement the collaborative care model in two of its Community Oriented Primary Care (COPC) clinics – Bluitt-Flowers Health Center and East Dallas Health Center. The clinics will use these funds to provide treatment to adults with depression.

An internationally recognized medical system, Parkland Health and Hospital System was established in 1894 to meet the health care needs of poor and medically indigent patients in Dallas County. In 1987, Parkland launched COPC, a model designed to improve the health of underserved individuals through accessible primary care and health promotion programs.

The Bluitt-Flowers COPC provides services to one of the poorest areas of the county, and the East Dallas COPC is located in a federally designated Medically Underserved Area. Both COPCs primarily serve Medicaid and "charity" patients. Building on the COPCs' existing integrated health care efforts, the IHC Initiative will enable the clinics to expand the scope of mental health services offered and deepen the collaboration between physical and mental health providers.

People's Community Clinic
A grant of $275,255 over three years was awarded to People's Community Clinic in Austin to treat adults with various mental health problems in partnership with Austin Travis County Mental Health Mental Retardation Center.

One of the oldest, continuously running clinics in the country, PCC has never wavered from its mission to improve the health of medically underserved and uninsured Central Texans by providing high quality, affordable health care.

At PCC, the primary care team directly engages the patient, using a preventive health care model. Through the IHC Initiative, PCC will expand upon its extensive record of providing effective, comprehensive primary care to interface mental health intervention with primary care service delivery.

Project Vida Health Center
Project Vida Health Center (PVHC) received a grant of $373,104 over three years to treat mental health problems in adults and children in its three El Paso clinics. This faith-based Federally Qualified Health Center will partner with Family Services of El Paso and El Paso Mental Health Mental Retardation for the initiative.

PVHC serves low-income families and is annually reviewed and evaluated by a Community Congress of over 100 community residents. With clinic sites in East Central and Northeast El Paso, PVHC provides a full spectrum of primary care services. The area is a federally designated Medically Underserved Area and Health Personnel Shortage Area.

Since its founding, PVHC has been recognized with numerous awards from both local and national organizations, including the Health Resources and Services Administration and the Department of Health and Human Services' Office of Minority Health.

Texas Children's Pediatric Associates
Through a partnership with Texas Children's Hospital, Texas Children's Pediatric Associates (TCPA) will use its grant of $306,570 over three years to treat children with attention-deficit hyperactivity disorder in its Ripley clinic, located in Houston's East End.

TCPA, a non-profit pediatric group practice, is a wholly owned subsidiary of Texas Children's Hospital. It is the country's largest group of general pediatricians, providing a medical home to approximately a quarter of Houston's children.

Of all Houston's neighborhoods, TCPA – Ripley's service area is home to the poorest population with the lowest educational level. TCPA – Ripley will use its IHC Initiative grant funding to provide care for the clinic's growing population of pediatric patients diagnosed with attention-deficit hyperactivity disorder who lack access to mental health services.

Valley Primary Care Network
Based in Harlingen, Valley Primary Care Network (VPCN) received a grant of $1,138,184 over three years to bring the collaborative care model to its four constituent community health centers – the Brownsville Community Health Center, Community Action Council of South Texas, Nuestra Clinica del Valle, and Su Clinica Familiar. The clinics will partner with Tropical Texas Center for Mental Health and Mental Retardation to treat a range of mental health problems in children and adults.

VPCN's mission is to establish a health care delivery network that achieves a seamless continuum of quality comprehensive health care, with a focus on increasing access to health care and decreasing disparities in health conditions.

VPCN's four community health centers provide a spectrum of primary health care services to the low-income, underserved people of the Rio Grande Valley. Although the Valley comprises both urban and rural communities, much of its population resides in the poor, rural settlements called colonias. Through the IHC Initiative, VPCN's health centers will provide mental health services to the Valley for the first time.