GettingINSHAPETaking care of the mind and bodypage 8

Integral care • Spring 2015

focus

Chief Executive Officer, David Evans; Chief Strategy Officer, Ellen RichardsEditor, Paul Carrubba; Design, Annie Lampton/Fanny Trang; Photography, Fanny Trang

focus

Board of TrusteesChair, Matt Snapp, PhD, CGP; Vice Chair, Richard E. Hopkins; Secretary/Treasurer, Robert Chapa, Jr.;

Terri Broussard Williams; Exalton A. Delco, PhD; Hal Katz; Vincent Torres; Tom Young; Guadalupe Zamora, M.D

Editorial Staff

Comments to communications@atcic.org

From the CEOpage 2

News & Updatespage 3

Guest ArticleBy Regina Rogoff, Executive Officer PCC

page 5

Staff InterviewWith Teresa Williams, Prevention

Services Practice Manager at AustinTravis County Integral Care

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Getting InShapeTaking Care of the Mind

and Body

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2 • Spring 2015

Today we know, based on a wealth of evidence, that mind and body are linked. Yet,health care is often still delivered in a system that maintains an artificial separation be-tween physical and behavioral health. This is finally changing and more providers areputting the ideals of integrated care into practice.

Integration of care means providing health care in a way that considers the needs of thewhole person—body and mind. The majority of individuals with serious mental illnessesalso live with chronic physical health needs. Studies show they die, on average, 25 yearsearlier than individuals in the general population. But they aren’t dying from mental ill-ness. They are dying from tobacco related illnesses and chronic diseases such as diabetesand obesity.

This disparity has many causes. Primary care providers may not be knowledgeableabout or comfortable treating mental disorders, while many mental health providers are

not trained to treat chronic physical conditions. Some medicines that treat mental illnesses can cause lethargy,weight gain, or intensify the effects of tobacco. Individuals living with a mental illness may not know where to seekhelp or lack the resources to get the help they need.

Integrated care makes it possible for people to access care that addresses their unique health needs by providingphysical and mental health solutions in one place. Providing comprehensive, person centered care for each individ-ual is the goal of integrated care.

Our vision is Healthy Living for Everyone. Today we recognize that to achieve our vision, we must work to meet allof the health needs of the individuals we serve, mental and physical. We also recognize that improving physicalhealth improves mental health and vice versa. Through partnerships with primary care providers like CommUnity-Care and Peoples Community Clinic and fitness experts such as the YMCA, we are truly helping individuals im-prove their lives through better health.

This issue of Focus highlights integrated care in our community and in our programs. I hope you will be inspiredby the innovative approaches to care and by our consumer who is changing her life for the better.

From the Chief Executive Officer

David Evans

CEO Cancer Gold StandardRe-accreditationIn April 2015, Integral Care earned CEO Cancer Gold Stan-dard™ re-accreditation from the CEO Roundtable on Cancer. Inorder to earn re-accreditation, Integral Care met specific re-quirements related to tobacco cessa-tion, nutrition and wellnesspromotion, staff insurance benefitsand more. This demonstrates ourcontinued commitment to support-ing the health of our employeeswhich includes prohibiting use of to-bacco products on all our propertiesand providing tobacco cessation sup-ports for anyone seeking to quit.

New Additions to MedicalLeadership TeamIntegral Care is pleased to announce that we have selected a pairof outstanding individuals for two very im-portant new leadership positions.

Dr. James G. Baker joined our executivemanagement team as Integral Care's newSystem Chief Medical Officer. He is aboard certified child, adolescent and adultpsychiatrist. Dr. Baker previously served asMedical Director for Behavioral Health forthe Texas Department of State HealthServices. In his new role, Dr. Baker will develop, implement andexecute policies, procedures and programs related to IntegralCare's medical staff and quality management unit. He will alsowork with our chief executive officer to develop and maintainrelationships with stakeholders and community partners.

Dr. Russell W. Bach began working for Integral Care as a staffpsychiatrist in 1992, and has served as Associate Medical Direc-tor since 1998. Dr. Bach is taking on the newly created role ofPsychiatric Services Medical Director. In his new position, Dr.

Bach will work collaboratively with Dr. Baker and provide lead-ership and administrative oversight for Integral Care's medicalstaff and clinical services while continuing to serve as a practic-ing psychiatrist.

Health Justice Learning CollaborativeIntegral Care and the Travis County Sheriff ’s Office (TCSO)kicked off a new partnership on April 1, 2015. We will be work-ing together on the Health Justice Learning Collaborative(HJLC), a new initia-tive that helps indi-viduals being releasefrom jail connect toneeded behavioralhealth services andsupports and make asuccessful transitionto life in the commu-nity. Travis Countywas one of only threecounties in the nation invited to take part in the HJLC by its de-velopers, the National Council for Behavioral Health and theMajor County Sheriff 's Association.

News & Updates

IntegralCare.org • 3

15th Annual Central Texas AfricanAmerican Family Support ConferenceIn February, Integral Carehosted the 15th annualCentral Texas AfricanAmerican Family SupportConference. Consumers,family members and pro-fessionals came togetherto learn about health re-sources and supportsthrough a diverse selec-tion of breakout sessions and speakers, including keynotes AllenLipscomb and former U.S. Surgeon General Dr. Regina Ben-jamin. Attendees also had the opportunity to interact with over40 local exhibitors. You can learn out more about the conferenceat www.ctaafsc.org.

Travis County Plan for Children’sMental HealthThere are approximately 43,000 children under the age of 18 inTravis County who have, or are at risk of developing, a mentalhealth disorder. Half of all mental illness begins by age 14. Earlyand effective prevention and intervention can improve the livesof our children. Together with community stakeholders frommultiple sectors, Integral Care developed a five-year-plan to im-prove mental healthcare for our childrenand youth. The planwas released at theHealthy Kids, Thriv-ing Community:Travis County Chil-dren’s Mental HealthSummit on Febru-ary 20. You can readthe full report here.Implementation of the plan kicks off in June.

Joint Commission Re-accreditationIn November 2014, surveyors from the Joint Commission vis-ited 16 Integral Care sites and programs to evaluate our qualitystandards across the agency. We are happy to report that in early2015, Integral Care received official notice from the Joint Com-mission of our re-accreditation. Thismeans that we are meeting nationalquality standards for care. The successof the survey was due to the dedicationof our staff to delivering quality pro-grams and services for our community.

News & Updates continued

4 • Spring 2015

IntegralCare.org • 5

Guest ArticleWritten by Regina Rogoff, Chief Executive Officer, People’s Community Clinic - PCC

Regina Rogoff is the Chief Executive Officer of the People’s CommunityClinic, a full-service, comprehensive and patient-centered family practicethat provides care for every age group. In 2014, PCC achieved Level 3(the highest level) Patient-Centered Medical Home certification from theNational Committee on Quality Assurance. The clinic is one of IntegralCare’s valued community partners in providing integrated care.

What does “integrated care” mean to you? To me, integrated care means that the behavioral health practi-tioner, the primary care practitioner and the specialist provider workcollaboratively to address individuals’ physical and mental health is-sues. The integrated care model is a holistic approach that allows in-dividuals to receive mental health treatment in the same location astheir primary care.

How does integrated care benefit the community at large? It increases access to much-needed mental health services. Manyindividuals with serious mental health issues frequently use high-cost community services like emergency rooms. If we can success-fully help them manage their behavioral health needs in a primary

care setting, we can decrease financial and human costs to the com-munity. Also, people with mild-to-severe mental health issues oftenconsult a primary care provider first. Thanks to integrated care, pri-mary care providers are becoming more comfortable, knowledge-able and skilled at providing mental health care.

What were some obstacles individuals faced before integratedcare was available? Barriers included the stigma attached to mental illness, transporta-tion problems, limited access to affordable services and the lack ofinsurance coverage parity for mental health care. In the past, we hadto refer patients elsewhere for behavioral health treatment, but pa-tients often didn’t follow through on the referrals. When they did re-ceive specialty mental health care, there was often little or nocommunication or collaboration between providers, so individualsoften felt adrift in the system. Primary care providers also experi-enced frustration because they frequently felt unqualified to addresspatients’ behavioral health needs.

How does PCC’s Integrated Behavioral Health Program work? PCC has integrated services available for every age group includingspecialized children’s and adolescent mental health services, an inte-grated chronic disease program and services to address post-partumdepression. We are adding an early-childhood prevention programthat we hope will decrease adverse childhood events for ouryoungest patients.

Our adult Integrated Behavioral Health (IBH) program treats indi-viduals with mild-to-moderate depression and anxiety, but we alsoinclude some patients with more serious mental health issues. Theprimary care practitioner (PCP) retains responsibility for the pa-tient’s care. The team includes on-site licensed clinical social workersand a consulting psychiatrist from Integral Care who may meet withthe individual, the therapist and/or the PCP. We regularly track pa-tient progress, and medication access is available through our 340bpharmacy benefit or our Patient Pharmaceutical Assistance Pro-gram.

People’s Community C linic

6 • Spring 2015

Can you share some of the IBH program’s successes?I’m proud to say we’ve had excellent results. In 2006, the HoggFoundation for Mental Health awarded PCC, and four other organi-zations, grants to implement the collaborative care model. The foun-dation’s multi-year evaluation of the programs found that PCC hadthe best overall outcomes. Half of PCC’s English-speaking patientsreduced their depression symptoms by 50 percent compared to thestandard care rate of 28 percent. PCC achieved even more successwith Spanish-speakers, of whom 78 percent experienced at least a 50percent reduction in depression.

Can you recall any specific individuals who particularly bene-fited from the PCC’s IBH program?Tina (not her real name), 59, suffered from PTSD and substanceuse disorder. She took medication, but her symptoms—especiallyanxiety—remained. Her physician referred her to PCC’s IBH Pro-gram. Tina met with the consulting psychiatrist to evaluate and ad-just her treatment. Regular psychotherapy helped her improve herself-esteem and emotional regulation.

PCC also used its Medical-Legal Partnership with the Texas LegalServices Center to help her get disability benefits and Medicaid cov-erage that allowed her to have much-needed surgery, relieving amajor stressor impeding her recovery.

Tina has made significant improvement. She’s even begun to lookfor work, saying, “I’m back to my old self again!”

People’s Community C linic

Integral Care’s Teresa Williams is a Practice Manager for Preven-tion Services with 10 years of experience working in communitymental health centers. She enjoys working with her team on a pro-gram that’s focused on getting people healthy.

How does physical health relate to mental health?Poor mental health is generally linked to an increased risk ofdeveloping chronic illnesses like cardiovascular disease and dia-betes. Programs like Integral Care’s Chronic Disease Manage-ment (CDM) program or the Whole Health Peer Supportproject teach and guide individuals diagnosed with seriousmental illness how to manage their medical conditions better inorder to help them live longer, healthier lives.

What kind of chronic illnesses are most common amongindividuals with serious mental illnesses?Mental illness is linked to quite a few chronic illnesses. De-pression, for example, has been linked to increased mortalityrates from cardiovascular disease, respiratory disease and can-cer.

Why do these individuals have higher rates of chronicphysical illnesses? A big factor is the high rate of tobacco use among individualswith serious mental illnesses. Also, the difficulty in accessinghealth care, psychiatric medication side-effects and higher ratesof obesity are also major contributing factors.

How does maintaining physical health help withmental health?Over the last year, individuals involved in our wellness pro-grams have shown major improvements in cholesterol levels,blood pressure and heart rate. They also report feeling better.They feel that they’re managing anxiety and depressionbetter too.

So you’ve seen a lot of improvement then?Not all the participants have had drastic physical health im-provements, but every person actively participating in theCDM program has made at least some improvement. Somehave gone from smoking two packs of cigarettes a day to onlysmoking three or four cigarettes a day. Even though we’d like tosee them quit totally, it’s still a big improvement. Others used tosuffer crippling anxiety at the thought of leaving their apart-ments. But now they are able to get out into the world and exer-cise at the YMCA every week. Most have learned aboutnutrition, and they’ve been able to take steps towards makingchoices that let them live healthier lives.

An IntegratedCare ApproachStaff Interview

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Click on the image below to hear consumersand Integral Care staff ’s testimonies

Getting InShape Taking Care of theMind and Body

8 • Summer 2015

The Lady Bird Lake YMCA’s workout space is a large, rectangularroom painted in tones of tan and taupe. A large mirror, severalbenches and racks for weights of varying sizes extend the length ofone of the long walls. Rows of workout machines occupy most ofthe space. The machines, with their jutting, grey metal arms andweights and wires, and the intensity of individuals going throughtheir regular routines can be intimidating. To a person with a seriousmental illness who may have trouble even leaving her house orapartment, the machines and the people working out on them canbe downright scary.

There’s one person in the room, however, that doesn’t seem to bebothered in the least the machines or people around her. The lookof focus and determination as she makes her way through her day’sworkout is inspiring. One phrase—the best piece of advice she saidshe ever got—echoes through her mind: “Do the damn thing.”

Her name is Mandy, and it wasn’t long ago that a scene like thiswould’ve been just a dream. Mandy suffers from a severe mental ill-ness. “It’s trying to kill me,” says Mandy.

Fortunately, she sought treatment for her mental health is-sues. However, during the treatment, Mandy experienced acommon side-effect of medications used to treat severe men-tal illness: weight gain.

“I was thinner when I was younger, but the medicationsmade me bloated, and I wasn’t happy” said Mandy. “It was de-pressing being so overweight.”

The weight-gain side-effect is a common problem for indi-viduals trying to maintain their physical health as well as theirmental health. Chronic physical health problems are verycommon among individuals with severe mental illnesses.Weight-gain, like in Mandy’s case, can worsen these underly-ing chronic conditions. Individuals with severe mental ill-nesses die, on average, 25 years earlier than their peers in thegeneral population. They’re also more likely to suffer fromobesity, diabetes, tobacco-related illnesses and more.

The combination of mental illness, treatment side-effectsand chronic conditions can intensify the lethargy suffered byindividuals with mental illnesses. When you combinelethargy with the host of other common obstacles — like lackof transportation or inability to pay for healthcare — takingeven the first step necessary to achieve or maintain physicalhealth and wellness can seem like an insurmountable task.

This is the sort of vicious cylce that Mandy found herselfin—seemingly hemmed in by both mental and physicalhealth problems. Luckily she had the will and that one pieceof advice in her head: “Do the damn thing.”

She did. She knew that she had to get healthy physically ifshe was ever going to feel better mentally. She bought a bookon losing weight which helped her get started on her newjourney. On her own, she went from 245 pounds to 195, but

IntegralCare.org • 9

she continued to struggle. “I had a lot of anxiety, a lot of nerv-ous energy,” she said. “I was uncomfortable in my body.”

Then, in December 2013, while waiting for an appointment atAustin Travis County Integral Care, she read about IntegralCare’s Chronic Disease Management (CDM) program.

**********Integral Care established the CDM program to improve thephysical health of individuals with severe mental and chronicphysical illnesses. The CDM program is meant to help reducethe life-expectancy gap between mentally ill individuals and therest of the population from 25 years to zero. The program fo-cuses on four areas: diabetes management, obesity manage-ment, physical activity and tobacco cessation. With a coach’shelp, each client first chooses an area on which to focus — ahallmark of person-centered care. Next, they develop a planwith specific goals. A sense of progress is critical to success andtoo many goals at once can be overwhelming.

With the plan in place, the CDM program’s multi-disciplinaryteam of specialists goes into action. The team includes an exer-cise specialist, a registered dietician, a tobacco-cessation special-ist and a whole-health specialist. The team members work withindividuals in their home, at the YMCA, the grocery store orwherever is appropriate and comfortable. The specialists moni-tor the individual’s biological data, helping them progress to-wards their health goals—mental and physical.

Thanks to a special partnership with the YMCA, individuals

entering the program receive financial assistance for member-ships. Other funds provide essentials such as workout clothes,cooking utensils and more.

“Their reactions are very positive when they see positive bio-logical data,” said Integral Care’s Amy Cosgrove, a service coor-dinator supervisor with the Chronic Disease Managementprogram. “They're very happy, and I've heard statements like, ‘Ican't believe I lost [this] much weight because I didn't think Icould do it.’ Of course, they're disappointed when their data isnegative, but my experience has been that most of them use [it]as motivation to work harder.”

Ultimately, the team’s goal is to help the individuals acquire thetools and skills they need to carry on and maintain a healthylifestyle on their own. As an individual becomes better able tomaintain health and wellness on their own, the frequency of ses-sions with the CDM team decreases.

**********As Mandy read more about the CDM program—the personalexercise training, the tobacco cessation program, help getting amembership to the YMCA—she decided to give it a try.

The CDM team taught her how to use the gym equipment,they helped her keep her appointments and much more. Susan,Mandy’s peer support specialist, had an especially large impact.Peer support specialists like Susan have lived experience withmental illness or substance use, sought recovery and use whatthey learned to help others do the same.

10 • Spring 2015

“[Susan] became a mentor, a friend, someone I could talk to,and could relate with me,” said Mandy. “She always kept up withme, and talking with her helped me make some really goodchoices in my life.”

Since she first began working with the CDM program Mandyfeels much better physically and mentally. Without it, she saysstarkly, “I’d be dead.”

She’s down to 163 pounds, and the improvements in her physi-cal health have yielded marked improvements in her mentalhealth and outlook. Mandy feels much more comfortable in herbody, she’s positive about the future, and she feels like she’s on agood path towards recovery.

These days, when you seeMandy at the YMCA, you’ll see acouple of things. You’ll see thelaser-like determination in hereyes as she blocks out everythingelse and focuses on counting outrepetitions and sets in her head.You’ll also see that she’s by her-self. Because one of the most im-portant things that CDM did forMandy was to help her gain theself-confidence to maintain herown health and wellness.

“I didn’t think I would keep itup. I really didn’t. But I look for-ward to my workout. I look for-ward to starting my day off withmy workout,” said Mandy. “I wantto do this, and I like doing it, anddamn it, I am doing it.”

I want to do this, and I like doing it,and damn it, I am doing it! “

”

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To learn more about InShape, visit Integralcare.org

P.O. Box 3548Austin, Texas 78764-354824-Hour Crisis Line512-472-HELP (4357)TTY: 512-703-1395

Visit us at IntegralCare.orgDonate at NewMilestones.org.