Darren Urada, Ph.D and Elise Tran, B.A.UCLA Integrated Substance Abuse Programs

CADPAAC / ADP Quarterly Meeting

January 23, 2013

Integration Survey of CADPAAC Administrators: 2012 Results

AcknowledgementsUCLA team, past & present: Valerie Antonini, MPH, Aaron Call, Sarah Cousins, MPH, Desiree Crevecoeur-MacPhail, Ph.D., Jia Fan, M.S., Thomas Freese, Ph.D., Rachel Gonzales, Ph.D., Grant Hovik, Adi Jaffe, Ph.D., Adam King, Sherry Larkins, Ph.D., Stella Lee, Allison

Ober, Ph.D., Brandy Oeser, MPH, Alex Olson, Howard Padwa, Ph.D., Diego Ramirez, Beth Rutkowski, MPH, Elizabeth Schaper, Suzanne

Spear, Ph.D., Cheryl Teruya, Ph.D., Umme Warda, M.S., Richard Rawson, Ph.D.

Funded by the:California Department of Alcohol and Drug Programs

The authors’ views and recommendations do not necessarily represent those of the funders, UCLA, or the UCLA Integrated Substance Abuse Programs.

About the Survey

• Follow-up to a similar 2010 Survey• Integration, training needs

– Are we moving in the right direction?– How far along are we?

Great Response!

Surveys e-mailed to each county (57)

• 2010: 44 counties (77% response rate)• 2012: 53 counties (93% response rate)

• Thank you!

Are BHPs* currently working to integrate AOD with PC/MH?

(2010 vs. 2012)

YES0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

57%

90%

2010 (n=44)2012 (n=51) * BHP=Behavioral Health Provider – County or county contract

MH, SUD, prevention, treatment, or recovery services.

“Don’t Know” (2010=1)

Are BHPs currently working to integrate AOD with PC/MH?

(2012 details)

None

With MH in PC

With PC

With PC and MH

0% 10% 20% 30% 40% 50% 60% 70% 80%

10%

10%

14%

67%

2012 (n=51)

If no current work, are BHPs planning to do integration in the next year?

Don’t Know(43%)

No(14%)

Yes(43%)

2012 (n=7)

2010 (n=-19) 2012 (n=7)0

5

10

15

20

25

30

35

40

45

50

32%

43%

YES

YES

If no current work, are BHPs planning to do integration work in the next year?

(2010 vs. 2012)

, don’t know= 47%

, don’t know=43%

Any PC services in SUD programs? (Other than NTP)

YES0%

5%

10%

15%

20%

25%

30%

35%

25%31%

2010* (n=44)2012 (n=51)

“Don’t Know” (2012=4)

*In 2010, we assumed that those who stated they were not doing integration work did NOT have SUD treatment providers licensed to have on-site primary care services (other than NTPs).

Any AOD services in PC settings?(2010 vs. 2012)

YES0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

23%

45%

2010 (n=44)2012 (n=51)

“Don’t Know” (2010=2; 2012=3).

Any AOD services in PC settings?*

YES - Recovery Support Services in Primary Care

YES - Primary Prevention Activities in Primary Care

YES - Treatment Services in Primary Care

NO

0% 10% 20% 30% 40% 50% 60%

14%

18%

31%

49%

2012 (n=51)

*Check all that apply. “Don’t Know” (2012=3)

Distribution of AOD services in PC settings (2010 vs. 2012)

75% or more

Between 50% and 75%

Between 25% and 50%

Some, but less than 25%

None (0%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

2%

13%

78%

10%

8%

12%

61%

2010 (n=45)2012 (n=51)

“Don’t Know” (2010=3; 2012=5).

Where integrated, types of PC Settings with AOD Services*

Private clinics

Private physician offices

Non-FQHC CHC

Other

FQHC look-alike

FQHC

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

4%

9%

22%

22%

30%

91%

2012 (n=23)

*Check all that apply. “Don’t Know” (2012=1).

Where integrated, AOD services offered in PC, part 1/2*

Education and information dissemina-tion

Brief intervention for drugs

Screening of pregnant women for AOD/SUD (e.g., 4 P’s)

Brief intervention for alcohol

Case management/coordination of services

Routine screening for alcohol

Routine screening for drugs

0% 10% 20% 30% 40% 50% 60% 70% 80%

57%

61%

65%

65%

65%

70%

70%

2012 (n=23)

*Check all that apply.

AOD services offered in PC, part 2*

Psychosocial treatment for nico-

tine

Brief intervention for nicotine

Recovery support services

Routine screening for nicotine

Psychosocial treatment for

drugs

Psychosocial treatment for

alcohol

0% 10% 20% 30% 40% 50% 60%

9%

17%

39%

43%

48%

52%

2012 (n=23)

*Check all that apply.

Barriers to Integrating AOD with PC*(2010 vs. 2012)

Legal barriers

Other barriers

Certification or licensing issues

Partnering with primary care providers

Documentation barriers

Financing barriers

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

10%

26%

42%

54%

68%

74%

13%

33%

29%

63%

63%

92%

2010 (n=24)2012 (n=50)

*Check all that apply.

Greatest Training Needs

Other

MI

Ethics and Confidentiality

MAT

Prescription Drug Abuse

SBIRT

Working in the Health Care System

Chronic Disease Associated with SUD/MH

Integration Strategies

0 5 10 15 20 25 30 35

2

3

13

16

16

21

23

24

31

2012 (n=50)

Level of AOD/PC Integration

(0) Not engaged in any activity related to integration

(1) Learning about integration

(2) Starting to communicate with primary care providers

(3) Planning integration initiatives with primary care providers

(4) Engaged in integration initiatives

0% 5% 10% 15% 20% 25% 30%

2%

26%

28%

16%

28%

2012 (n=50)

Level of AOD/PC Integration(2010 vs. 2012)

(0) Not engaged in any activity re-lated to integration

(1) Learning about integration

(2) Starting to communicate with primary care providers

(3) Planning integration initiatives with primary care providers

(4) Engaged in integration initiatives

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

2%

26%

28%

16%

28%

43%

7%

21%

17%

12%

2010 (n=42)2012 (n=50)

Percentage of SUD treatment providers billing private insurance

75% or more

Between 50% and 75%

Between 25% and 50%

Some, but less than 25%

None (0%)

0% 10% 20% 30% 40% 50% 60%

6%

10%

12%

34%

20%

7%

2%

7%

51%

23%

2010 (n=26)2012 (n=50)

“Don’t Know” (2010=4; 2012=9).

Is your county involved with safety net programs to prepare for 2014?

Projects include:• CMSP• LIHP• Dual Eligibles• Path-2-Health

No (22%)

Yes (74%)

Don’t Know (4%)

2012 (n=49)

Structure of BH and Health Services(2010 vs 2012)

MH, SUD, and health services in 1 department/agency

MH, SUD, and health services in 3 separate departments/agencies

BH services (MH and SUD) under 1 department/agency; health services separate

Some other structure

0% 10% 20% 30% 40% 50% 60%

26%

4%

56%

14%

31%

5%

48%

17%

2010 (n=42)2012 (n=50)

PC in SUD vs. AOD services in PC

YES0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

31%

45%

PC in SUD (n=51)SUD in PC (n=51)

“Don’t Know” (PC in SUD=4; SUD in PC=3).

Funding: AOD services in PC vs PC in AOD pgms

Medicare

Drug Medi-Cal

Other Grants

Federal Block Grant

Other

Private Insurance

Enhanced Medi-Cal

Self Pay

Medi-Cal

MHSA / Prop 63

0% 10% 20% 30% 40% 50% 60% 70%

44%

44%

25%

38%

44%

56%

63%

9%

17%

17%

22%

22%

26%

35%

35%

39%

48%

SUD in PC (n=23)PC in SUD (n=16)

*Check all that apply. “Don’t Know” (SUD in PC=1).

Service Delivery Model: PC in SUD vs. AOD services in PC*

Co-located Partly integrated Fully integrated Other0%

10%

20%

30%

40%

50%

60%

38%25%

19%6%

24%33%

48%

5%

PC in SUD (n=16)SUD in PC (n=21)

*Check all that apply. “Don’t Know” (PC in SUD=2).

Interest in Collaboration:Integration Learning Collaborative (ILC)• Great interest in ILC participation:

– 39 counties would like to participate or continue participation

– 14 counties would be willing to present their county's integration work in the ILC. We have some great ideas planned!

• Next meeting will be on February 27, 2013 and will feature a panel of rural counties

Integration Learning Collaborative

• Interactive forum where county administrators and other key stakeholders collaborate to identify successful models of integration and solutions to challenges. See:

http://www.uclaisap.org/Affordable-Care-Act/html/learning-collaborative

• These slides will be available shortly at this website.

Progress

We’re not there yet, but we’re moving in the right direction!

Questions?

CONTACT

Darren Urada, Ph.D.UCLA Integrated Substance Abuse Programs durada@ucla.edu

Thank you!