INTEGRATION
IN AMADOR COUNTY
BEHAVIORAL HEALTH
DEPARTMENT
AMADOR COUNTY’S STORY
LESSONS LEARNED in IMPLEMENTING INTEGRATION PROCESS
Lessons Learned from HRSA’s early demonstration projects in
primary care and behavioral health care integration:
Organization needs to determine ―Integration of what?‖
No single path to achieve integration
Organizational environment and culture shape the model of
integration
Funding alone does not insure integration occurs
Multi-year process
Program evaluation and CQI help guide and improve the process
AMADOR COUNTY’S STORY
HISTORY OF ORGANIZATIONAL INTEGRATION
FY 06-07 – „You can‟t make me love you”
• Board of Supervisors Resolution
– WHY? – presented to BOS as an efficiency move
– Combine ADS Dept and MHS Dept into
organizational unit
– Named combined department Behavioral Health
– One director to replace 2 previous positions
• Organizational development consultant hired for 1
year to effect more collegial relationship between
the MHS & ADS staff
AMADOR COUNTY’S STORY
FY 07-08 – “Getting to know you”
• New director hired from outside the County
• Individual consults by new director with every
staff member
• Conjoint All Staff meetings
• Joint membership workgroups
• Move to new space
• Increased opportunities for socialization
AMADOR COUNTY’S STORY
FY 08-09 – “One for All; All for One”
• Fall of 08 discovered serious financial deficit in
ADS programs
• Hx of borrowing from each other’s funding and
from the Public Health Trust
• Layoffs required – offered new jobs
• DUI and PC 1000 let to community contractor
• Integrated CCS-MHSA funds in the FY 10 Budget
throughout entire Dept
• Need for more contemporary methods of
treatment and care
AMADOR COUNTY’S STORY
FY 08-09 - “One for All; All for One”
• Investigated various EBP models of care,
– ―Integrated Recovery Team Model‖
– ―Integrate Dual Disorders Team‖,
– ―Aggressive Case Management Model‖ ,
– ―Comprehensive, Continuous, Integrated System Of Care
Model‖
• Established ―Integrated Recovery Teams‖ with
features from each of the above models
GOAL:
ACHIEVE COMPREHENSIVE,
COORDINATED, CLIENT
CENTERED, RECOVERY
ORIENTED CARE FOR EVERY
BHD CLIENT
AMADOR COUNTY’S STORY
INTEGRATED RECOVERY TEAM CHARACTERISTICS
Membership of IRT
Core: Mental Health Clinician, Alcohol &
Drug Counselor, and Personal Services
Coordinator, Medical Records Clerk
Adjunct members: Patient Advocate,
Family Advocate, Community-based
partners
PRN: BHC Nurse, Psychiatrist
AMADOR COUNTY’S STORY
• Team = most important function in Dept
• Each client has a team working for them—
not an individual caseworker!
• Each member of the team needs to be
competent at a ―minimum base‖ of
knowledge and skills
• Agenda driven team meetings twice/week
for review and planning treatment plans
and case work activities;
• Clients and their family members
encouraged to attend treatment planning
AMADOR COUNTY’S STORY
• Ongoing communication between team members
re: role differentiation and expertise
• Cross training improves functioning and
continuity of care
• Team decision making on every case re: medical
necessity, tx plans, case management activities,
etc.
• Crisis stabilization, including discharge planning,
is responsibility of the team whenever there is a
crisis, hospitalization, or other residential
admission
AMADOR COUNTY’S STORY
CHARACTERISTICS OF THE INTEGRATED PROCESS
• Access to service can be through department,
referral resource, community-based partners,
consumer wellness center
• Universal Intake Process
• Universal registration tool
• Universal financial screening process
• Clients receive the most appropriate service for
their current need(s)
Amador County’s Story
CHARACTERISTICS OF THE INTEGRATED
PROCESS
• Flow between mental health and alcohol &
drug services is not apparent to the client
• Funding clients’ services must be closely
monitored; can be tied to service codes
• Every care and treatment staff positions
are partially funded with MHSA funds to
insure capturing all funding streams for
the services they provide uninsured.
AMADOR COUNTY’S STORY
ISSUES & CHALLENGES OF ORGANIZATION
AND SERVICES INTEGRATION
• Fear of Change –
– Dominance of one group over the other
– Letting go of individual clients
– Lack of confidence in the team process
• Need for training and ongoing support
• Expense and loss of revenue due to initial training
needs
Administrative change in focus towards the
facilitation of the teams
AMADOR COUNTY’S STORY
• Professional and consumers working side-
by-side
• Finding a IM system to accommodate
recovery model and team caseloads
• Buy-in from psychiatrist
Amador County’s
Story
Presented by:
George Sonsel, L.C.S.W.
Director, Behavioral Health
Department
10877 Conductor Blvd, Suite 300
Sutter Creek, CA 95685
(209) 223-6296
gsonsel@amadorgov.org