Human Services and Behavioral Health Integration: A Model for Whole-Person Medicaid Managed Care.

A comprehensive, whole-person approach to individuals' health care can be achieved by aligning, integrating, and coordinating health services with other human services. HealthChoices, Pennsylvania's managed Medicaid program, delegates responsibility for Medicaid-funded behavioral health service management to individual counties or multicounty collaboratives. County administrators' programmatic and fiscal oversight of Medicaid-funded services allows them to create synergies between behavioral health and other human service delivery systems and to set priorities on the basis of local needs. This model supports access to community-based care, integration of general medical and behavioral health services, and programs that address social determinants of health.

Effectiveness of a Staff Promoted Wellness Program to Improve Health in Residents of a Mental Health Long-Term Care Facility.

The current study describes physical and mental health outcomes during a health promotion program for individuals with serious mental illness (SMI). A sample of 43 adults in a long-term residential facility volunteered for an individualized, healthy lifestyle program designed to promote physical activity and combat premature mortality among individuals with SMI. Nurses and residential counselors were trained in the program and encouraged to work collaboratively with the program's personal trainers. Weekly nutrition and activity logs were obtained over the year-long evaluation. Assessments of physical and psychological health indicators were collected quarterly. Qualitative data through focus groups described staff experience. Self-report of moderate and vigorous physical activity improved over time as did fitness level as measured through a walking challenge (p = .001). Significant decreases in weight (p < .001), BMI (p = .001), and total cholesterol (p < .001) were observed from baseline through 12 months. Mean recovery scores (RMQ) were significantly higher between baseline and all time points (p < .001). Participants reported decreasing levels of depression (PHQ-9) by the 12-month time point (p < .001). Staff encouraged participation in physical activity and observed improved motivation and socialization among participants. A health promotion program with participation encouraged by health care staff is effective for increasing physical activity and improving physical and mental health outcomes in individuals with SMI in long-term residential care.

Brief Critical Time Intervention to Reduce Psychiatric Rehospitalization.

OBJECTIVE: The study investigated the association between implementation of a brief critical time intervention (BCTI) model and occurrence of early and long-term psychiatric readmission of adults with serious mental illness. METHODS: A sample of 149 adults with a psychiatric inpatient readmission within 30 days of a prior psychiatric hospitalization was referred to an acute level of service coordination (ASC) available at six provider organizations implementing BCTI. Activities important to the delivery of BCTI were monitored and supported. A comparison cohort of 224 adults served by ASC at the same organizations before implementation of BCTI was derived from administrative data. Frequencies of behavioral health service utilization and readmission rates for the intervention and comparison cohorts within 30 and up to 180 days of the prior readmission were compared. RESULTS: Utilization rates of mental health and substance use disorder services were similar for both cohorts postdischarge. The proportion of individuals readmitted within 30 days of a discharge was lower for the BCTI cohort (28%) than the comparison cohort (47%) (p<.001). Longer-term readmission rates also were lower in the BCTI cohort but were not significantly different from the comparison cohort (44% versus 52%). With analyses controlling for patient characteristics and service utilization, individuals in the comparison cohort were 2.83 times more likely to be readmitted within 30 days than those who received BCTI (p<.001). CONCLUSIONS: BCTI was associated with decreased early readmission rates, suggesting that this model may be an effective approach to improve continuity of care for this population.