The Center of Excellence assists health care clinics and systems in integrating their physical and mental healthcare. Our philosophy is simple: build buy-in across the organization and use evidence-based approaches flexibly to fit local needs. Our mission is to spur the creation of evidence based integrated care Models across health systems to improve the mental and physical healthcare of primary care patients and clients of mental health homes. We believe these models have great potential to decrease inappropriate utilization of healthcare resources such as some emergency department visits and therefore impact costs, especially among segments of the population that traditionally over-utilize resources. We use systematic tools and processes to help clinics determine their current state and needs and provide the nuts and bolts technical assistance needed from the board room to the exam room.
We Define integrated care functionally. That is, we believe integrate care can incorporate various elements but must meet certain goals. These include that the integrated care design should be evidence based and therefore able to be replicated across systems and clinics. Integrated care efforts should also be population based and therefore be able to show evidence of impact across populations compared to usual care. Integrated care efforts should also coincide with the prevailing goals of the health system in line with the Triple Aim and Patient Centered Medical Home movements. When integrated care efforts meet these goals we call them Models. When they do not meet all these functional criteria we call them Programs. The COE works with clinics and systems at all levels of integrated care from sites without any current efforts to sites with existing programs or models.
How we define Models.
Models of Integrated Care
There are currently three models that have been defined in the literature and practice of integrated care. These are, the Primary Care Behavioral Health (PCBH) model, the Collaborative Care model, and the SBIRT model. These are considered models because they are evidence-based, have a clearly defined work force with defined roles, are able to be replicated and are population based strategies. Each have demonstrated improvement compared to usual care. The PCBH model is a generalist model that places a Behavioral Health Consultant alongside the primary care provider real-time to meet a variety of patient needs. The Collaborative Care model focuses on improving the care of depression through the use of a registry to track depressed patients and a consulting psychiatrist to improve medication treatment. The SBIRT model places a bachelor's or master's level mental health provider in the primary care setting to screen for substance abuse issues and provide brief intervention to patients with mild to moderate substance abuse problems. These are not mutually exclusive models and therefore can run concurrently. At present there are no established models for mental health sites integrating primary care services however there are evidence based components, such as the Million Hearts program, which can be integrated with confidence into a mental health home framework.
How We Define Programs
The terms programs and models are often used interchangeably, however, we define programs differently than Models. Programs are site specific efforts that are not necessarily guided by the evidence found in the integrated care literature and are tailored to protocols and desires known only to the site. This then makes programs impossible to replicate or compare across differing organizations. Many sites choose to establish such programs for a variety of reasons including lack of access to the right personnel to run certain models, lack of implementation expertise or simply a desire to tailor services according to their understanding of their patient base needs. Many sites find themselves running a program before they are able to implement the designs of full-fledged models such as the PCBH or Collaborative Care models since developing such models often occurs in incremental or developmental steps based on site readiness and other factors. Our goal is to help more sites reach the stage of their efforts where they can be measured as running a model versus a program. We measure a site's integration level using a tool called the MeHAF.
By definition integrated care efforts should improve the access patients have to quality mental and physical healthcare. Therefore population Reach or penetration is a key attribute that defines effective Models. The idea is that integrated capture helps to capture a larger proportion of the population than primary care as usual or specialty mental health care as usual and provides an intervention that can be sustainably applied to that population. This reach can be captured in statistics such as:
Numerator: Number of patients treated with integrated care
Denominator: Number of patients in the clinic population
Models such as the Collaborative Care model have a defined reach limited often to patients with a diagnosis of depression. Models such as the PCBH model are generalist in nature and therefore have the potential for broader reach across patient categories.
How we define Programs.
How we define Reach.
Director of Operations
Christine Borst, PhD, LMFT
Dr. Christine Borst has a master’s degree in Marriage and Family Therapy from Purdue University and a PhD in Medical Family Therapy from East Carolina University. Prior to joining the Center of Excellence team, Dr. Borst spent nearly several years working in a rural community health center to set up and implement an integrated care model. Her research interests include brief behavioral interventions for use in medical settings, and identification of the needs of children and their families in rural integrated care.
Monica Harrison, MSW, LCSW
Monica W. Harrison is a Licensed Clinical Social Worker with over 11 years in behavioral health integration throughout North Carolina. She has provided direct clinical service to children and adults in an FQHC primary care health practice and nephrology center. As a clinician, Monica has utilized several models for providing brief interventions including SBIRT, PCBH and collaborative care. Monica’s diverse professional background has also provided her with executive leadership experience as the social work manager over 14 dialysis centers from Greensboro to Charlotte, and as the behavioral health manager of an FQHC with seven sites across the Piedmont. Monica is also an esteemed alum of the Joint Masters of Social Work Program of North Carolina A&T State University and the University of North Carolina at Greensboro.
Amelia Muse, PhD, LMFTA
Amelia has a master’s degree in Marriage and Family Therapy from East Carolina University and a doctoral degree in Medical Family Therapy from East Carolina University. Prior to joining the Center of Excellence team, Amelia spent four years working as a behavioral health consultant in medical settings. She spent two years working in a rural community health center, and one year as a clinician-researcher implementing an integrated care model in a hospital clinic. Her research interests include evaluation of success and sustainability of integrated behavioral health models in primary care settings, and policy development to integrate behavioral health services to address population health needs.
Sara Herrity, MS, LMFT
Sara Herrity joined the Center of Excellence for Integrated Care (COE) as an Integration Consultant in March, 2017. In her role, Sara provides technical assistance to a variety of healthcare professionals and organizations, particularly bidirectional settings and organizations that work to connect patients to a larger network of services. Sara's role includes providing resources, trainings, techniques, shadowing and consultation for those working to enhance their level of integration. Prior to joining COE, Sara spent over 4 years providing therapy services in a variety of contexts including traditional therapy at a community mental health agency in Raleigh, at a middle school, and at a church providing premarital counseling, as well as conducting comprehensive clinical assessments for substance abuse/homeless women seeking mental health services. Earlier this year, Sara also became certified in Trauma-Focused Cognitive Behavioral Therapy for children and adolescents.
Sara holds a bachelor of arts degree in Psychology from the University of North Carolina at Chapel Hill and a master’s degree in Marriage and Family Therapy from East Carolina University.
Eric Christian, MA, LPC
Eric Christian is a Licensed Professional Counselor and a nationally certified counselor who has been working in the field since 1998. For the past eight years he has been working in the area of Integrated Care in western NC promoting the systemic spread of behavioral health integration into primary care settings to serve larger populations of patients with behavioral health needs. He works as the Integrated Care Manager for Community Care of Western North Carolina, where among other efforts, he provides technical assistance and consultation to providers interested in integration. Mr. Christian coordinated and managed an annual state-level integrated care conference for several years, as well as a national conference in 2007. Eric took part in designing and implementing regional telepsychiatry and consulting psychiatry models, and wrote ICARE 102 as an online resource guide for implementing integration. In 2012 Mr. Christian co-edited an Integrated Care text titled, Integrated Care: Applying Theory to Practice, which included author contributions from state and national integrated care practitioners.
Lisa Tyndall, PhD, LMFT
Dr. Lisa Tyndall joined the NC Center of Excellence for Integrated Care (COE) as a Technical Assistant in June 2016. In her role, Dr. Tyndall provides technical assistance for integrated care program development to a variety of medical practice settings. Her responsibilities include shadowing and one-on-one consultation, offerings of trainings, webinars, regular phone consultation and provision of resources and reference materials.
Prior to joining COE, Dr. Tyndall spent six years working as the Family Therapy Clinic Director for East Carolina University. A licensed Marriage and Family Therapist, she has over ten years of experience serving in various research, instructor, and clinical positions related to both marriage and family therapy and integrated care in North Carolina.
Dr. Tyndall has a master’s degree in Marriage and Family Therapy and a doctorate in Medical Family Therapy, both from East Carolina University.
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OUR QUALITY COMES FROM OUR ATTENTION TO THE DETAILS OF INTEGRATED CARE AND TO THE NEEDS OF OUR CLIENTS
Working with the COE means working with experienced professionals with both clinical experience and technical assistance expertise. We usually begin our journey with clients with strategic meetings to define the scope of the work and the timetable. We quickly work to get on the ground as quickly as we can to promote fast learning across the organization. We use a variety of tools including project management software and online learning module software to promote this learning. Our work can take many shapes but can include: