Implementation

We have over 20 years of experience helping organizations implement evidence based practices for behavioral health.  The types of organizations we have partnered with over the years include community-based nonprofits, healthcare organizations, schools, state government agencies, and tribal entities.  More recently, we have been engaged in several large scale, statewide efforts to integrate behavioral healthcare into medical settings including the SBIRT process.  SBIRT stands for Screening, Brief Intervention and Referral to Treatment.  Listed below are the Essential Elements for Behavioral Health Integration as well as additional free resources for download.

1. Adapting Organizational Culture

Building motivation and readiness with all involved stakeholders (e.g. agency administrative departments, medical departments, different provider groups, consumer advocates) is key to any successful organizational change.  At C4BHI, we collaborate with the agency's key administration and team champions (medical or other) to ensure rapid and wide spread "buy in" for any shifts in culture necessary to ensure activation for population health adoption.

2. Gaining supervisory "buy-in" for all staff types

We fully realize the necessity of including each specialty within an organization’s practice (from front desk staff to providers and administrators) to enable holistic, effective and efficient team work.  Getting early and continued commitment from supervisors in each specialty and including them in developing new protocols greatly increases our success.

3. Finding a Champion for Integration

We help organizations to identify the most suitable individual to become the integration champion.  We work alongside the identified champion to help them become a continued source of information and motivation, as well as the ability to express the needed authority to make integration happen across the entire program.

4. Training of All Staff in Consumer Centered Techniques

Our experienced and effective clinical skills trainers create access for all staff and providers to easily receive online and in person training.  All involved staff will be matched to the amount of training necessary to utilize the decided-on approach.  For example, in implementing the SBIRT process, Motivational Interviewing (MI) is a key strategy.  However, the range of MI training depends on staff roles: a) front desk receive less intensive MI training, b) providers receive more training/coaching in MI skills and c) behavioral providers (MSW, LICMH, LADCs) receive the most training/coaching in MI, Motivational Enhancement Therapy, SBIRT, and Cognitive Behavior Therapy.

5. Establishing Clinical Protocols for which, when and how consumers will receive each component of the intervention.

At C4BHI, we collaborate with the champion and department stakeholders to align and "fit" the integration strategies into existing clinical workflows. Again, using the SBIRT model as an example:

• Screening is comprised of a brief initial triage screen followed by a secondary risk screen if indicated. Scores from secondary screens allow for risk stratification into no, low, moderate, or high risk.
• Risk stratification determines level of intervention from Brief Interventions (BI), embedded Brief Treatment (BT), and Referral to Treatment (RT).
• When a Referral to Treatment is the next step, making sure patients are ‘linked’ to referral agency by scheduling appointments prior to patient leaving medical clinic and obtaining a signed shared release of information sent to the referral agency.
• Follow-up conversations and check-ins.

6. Client Feedback and Satisfaction

Our C4BHI team is experienced in helping to engage with an organization's clients (customers, patients etc.) to document their change process, satisfaction, and feedback.  We are skilled in following-up and interacting with clients to ensure client collaboration takes priority and any stated needs are successfully communicated with the host organization.  We document the change related results in easy charts to share with organization stakeholders and funders.

• For example, in our SBIRT projects we've recruited close to 1000 clients in successful six-month follow-up interviews. Our outreach process allowed interviews with eighty percent of those consenting and 20% of the follow-ups resulted in re-engagement for care.

7. Sustainability

We understand that efforts toward sustainability including all aspects of organizational involvement need to happen from the "get go". Organizational changes only survive when there is a sustainable path toward funding and workforce development.  Provider and staff turnover are a reality and thus planning early for ongoing orientation and training ensures consistent and long-term success.

Note: Programs without a culture of integration do not ‘own’ the process of SBIRT.  Instead, they will tend to see the SBIRT process as part of the behavioral health provider’s duty.  A strong integration culture sees the screening and intervention as part of the core work of the clinic across staff and does not solely rely on the embedded behavioral health providers to do secondary screening and intervention.  Instead providers (nurses, PAs, physicians) will provide interventions when needed.