A Track Record of Success
Recipient: APA Gold Achievement Award
“…in recognition of strengthening families by...innovative and effective outpatient mental health, substance abuse and primary care treatment to urban, high-risk women, their children and families…”
The Center for Mental Health
Washington D.C.
Robert Woods Johnson grantee
Before:
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Large, horizontally organized safety net clinics serving 3,000 low income children and adults in Washington, D.C. with narrow range of mental health services – primarily long-term psychotherapy and medication management
Substance use, group and family supports not a part of operations
Largely uninsured or under-insured populations
Poor outcomes for highest risk populations
After:
Programs and services restructured around high-risk populations from infancy to old age, including people with serious mental illness
Integration of mental health and substance use; family service and support become central to care along with group and milieu treatments
Infusion of federal, local and national foundation funding together with Medicaid
National cross-site study (University of Illinois) revealed CMH as two standard deviations above other sites in achieving treatment goals: sobriety, safe reunification and reduced in-hospital days -- a major shift in outcomes for the highest-risk populations.
Concord , CA
Design for Integration of Primary Care (IPC)
into a Specialty Behavioral Health Setting
.. Dr. Ferman was a Godsend. I had been working on improving medical care for seriously mentally ill people in two separate regional clinics over 18 years. We would move one step forward and two back. It is not like the direct service staff did not know they needed better medical access. Mental health staff across the nation know they can't get adequate care for the psychiatrically disabled. We had probably three or four failures at achieving even minimal integration when Johanna engaged with our clinic. There was a demoralization – a numbness that had taken place.show more
Former Program Manager and Director, Concord Mental Health Clinic
Central County
Contra Costa County’s Mental Health Division
November 2011
Before:
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County’s largest free-standing mental health clinic 2,300 enrollees without ease-of-access to primary care
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Broadly acknowledged poor health outcomes and prevalence of diabetes, tobacco use and cancer; high hospital re-admissions for physical and behavioral health
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Staff burnout with inordinate time expenditures attempting to assure access for health related conditions
After:
Design work with primary care and behavioral health staff, consumer and family input to develop fully integrated model -- bringing primary care into specialty behavioral health setting: Concord Integrated Primary Care (IPC) designed as FQHC satellite to allow for seamless operation and financial sustainability
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Substantial ‘working bridge’ developed between adult mental health and primary care
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Identification and work with medical leadership to generate clinical practice guidelines, including patient flow and critical indicators
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Physical space planning, design and construction of new IPC initiated
Licensure pending as FQHC satellite
Workforce issues of cross-training, support and pride in achieving improved outcomes for our most vulnerable populations central to this model
Richmond Health Center
Richmond, California
Pilot Integrating Behavioral Health into Primary Care
“In nearly 20 years with Contra Costa Heath Services, I’ve seen no one else who has been able to design and create a working program in a complex, resource starved environment. Dr. Ferman is literally the first person who took the time to embed herself as a behavioral colleague into our high volume, fast-paced primary care practice and to emerge with a coherent sense of what needed to be done without a lot of going around and around…” show more
West County Supervisor Department of Family Medicine
Contra Costa County California
September 2011
Before:
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A high volume public primary care setting (FQHC look-alike)
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High prevalence of behavioral health conditions not identified and treated early
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Complex co-morbidities and complicated chronic illness with escalating costs
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Increasing burnout of a dedicated primary care workforce
After:
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Integrated Pilot with ‘core team’ developed with primary care ‘hosts,’ nursing, Wright Institute health coaches/psychology graduate trainees and consult liaison psychiatry with social work and support staff
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Behavioral screening, individualized and group treatment of mild to moderate conditions initiated for core team patients with triage to specialty behavioral health
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Greater support for primary care providers with more access to behavioral health screening, services and skill development evidenced by tripling of interested primary care providers and doubling of psychology trainees in the second year resulting in improvements in burn-out for participating Primary Care Providers
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Shift in patient outcomes for depression, psychosis, weight management and diabetes control.
