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Proceedings of a Workshop
Pages 1-90

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From page 1...
... . Of those with an SUD, approximately 60 percent also have a mental health disorder (Center for Behavioral Health Statistics and Quality, 2015)
From page 2...
... adults with mental illness received treatment (NAMI, 2019)
From page 3...
... Those values and principles translate into warmly welcoming everyone who comes through the doors of the mental health center and "meeting people where they are" with regard to their mental health status. The health centers' care model focuses on inclusion, participation in the community, and helping 2 For additional information, see http://www.nationalacademies.org/hmd/Activities/ MentalHealth/MentalHealthSubstanceUseDisorderForum/2019-OCT-15.aspx (accessed January 14, 2020)
From page 4...
... (LaBelle, Machtinger, Pomerantz, Reiss-Brennan) • Establish and create linkages between self-care and informal health care, primary care, and specialty care, all of which are essential components of care.
From page 5...
... (Wiest) • Enable primary care providers to improve care for patients with a history of MHSUDs by facilitating their access to patient health records.
From page 6...
... Addressing the Social Determinants of Health • Focus on social care to effectively address poor outcomes in health, mental health, and SUDs.
From page 7...
... (Durham, Greenfield) • Make screening, prevention, and treatment of MHSUDs part of the standard data system measures for community health centers, and link those measures to funding.
From page 8...
... Myrick noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) has produced several briefs that discuss peer support as part of mental health and substance use care.3 She also pointed out that the National Alliance on Mental Illness 3 SAMHSA's peer support briefs are available at https://www.samhsa.gov/brss-tacs/ recovery-support-tools/peers (accessed November 1, 2019)
From page 9...
... utm_ source=direct&utm_campaign=circleofcare (accessed November 1, 2019)
From page 10...
... , explained that trauma-informed health care5 is a powerful and essential tool to effectively address MHSUDs. "Understanding the impact of trauma on health demystifies why so many patients struggle with substance use and mental illness in the first place and why these conditions are often so refractory to supposedly effective therapies.
From page 11...
... "For us to sustain a movement of healing for substance use disorder and mental illness, we have to take this burnout seriously and adopt trauma-informed practices that support team-based care, reflective supervision, and self-care," he noted. Ultimately, understanding the impact of trauma on health and behavior helps health care clinicians be more patient and compassionate and enables them to form trusting connections with patients that are foundational for effective care of people with MHSUDs.
From page 12...
... "It is a model that we should all know about and build upon to be successful in overcoming our country's opioid epidemic and to effectively address other forms of substance use disorder and mental illness," he said. Machtinger encouraged the use of examples of effective care to guide the development of care delivery approaches for people with MHSUDs.
From page 13...
... t These experiences allowed Pebbles to talk openly about her HIV status and history of sexual abuse as a child and adult. This, in turn, helped her form new, strongly supportive friendships that facilitated her reengagement with her family, including one of her two daughters, and eventually enabled her to graduate from the resident treatment program and locate subsidized housing.
From page 14...
... Empowerment Screen and refer for other Partner agencies in community addictions and mental illness Cultural humility Motivational interviewing Leadership support and and responsiveness funding for comprehensive care SOURCE: As presented by Edward Machtinger, October 15, 2019.
From page 15...
... Early AIDS patients, as with most people with SUD and mental illness, were from highly marginalized populations, and they faced a stigmatizing and often uniformly fatal illness. At the time, clinicians did not have the expertise or tools to effectively fix the problem in front of them.
From page 16...
... The Ryan White Care System8 currently serves more than half of the p ­ eople diagnosed with HIV/AIDS, or almost 600,000 people, and after 30 years of operation, it has become the nation's safety net for people living with HIV. "The revolutionary power of Ryan White comes from how it funds outpatient treatment and care," said Machtinger.
From page 17...
... The Ryan White system of AIDS care was at its best when new, effective biomedical treatments were integrated into a system that saw people as people and did everything they could to help them survive," he said. "That combination was the best care this country has ever provided, and we have a rare opportunity right now to realize that model of care for substance use and mental illness," concluded Machtinger.
From page 18...
... "They work that way because they are perfectly equal with the people that they are serving, and they work from a knowledge base of ‘I have been through that and I understand what you are going through,'" she said. Peer supporters, she explained, do not direct
From page 19...
... In St. George's view, this is why community treatment is important, as it creates the opportunity for health care providers and peer supporters, for example, to spend more time with people and come to understand what the patient truly needs in order to fully engage with their treatment.
From page 20...
... At the same time, he said, primary care and behavioral health are often held accountable for increased spending without considering the broader cost savings created by increased expenditures in both sectors. "That is why I feel so strongly that we need to have a more structured national response to substance use and mental illness that really looks at this holistically and does not rely on innumerable valiant but fragmented efforts throughout the country to accomplish what we really see as shared goals," he said.
From page 21...
... Edison Professor of Psychiatry, Emerita, at Columbia University, stated the charge for the second session: given that research has outlined what the optimal interventions are for MHSUDs, the panelists were asked to identify the essential components of care for different disorders and ways to monitor whether effective care is being provided. The Veterans Affairs Integrated Care Experience Andrew Pomerantz began his presentation by reviewing the lessons learned from systematic research on translating evidence into practice: • Screening alone is at best inadequate to improve care; • A collaborative care model improves outcomes with limited initial cost; • Health psychology improves outcomes for many conditions; • Colocation of mental health and substance use services in primary care settings is necessary but not sufficient for improving care; • Measurement-based care improves clinical outcomes at the same or lower cost as traditional care; and • Peer support improves engagement in treatment, leads to better outcomes, and saves money.
From page 22...
... He explained that this is why the VA is working hard to integrate mental health care and primary care in the Patient Aligned Care Teams that are the VA's version of the patient-centered medical home. Pomerantz noted that VA integrated care has two key components.
From page 23...
... Pomerantz explained that the facilities that have implemented this model have realized clinical outcomes that are as good, or better, than those from specialty mental health care. Other positive outcomes for VA facilities that have implemented the integrated care model include • Improved identification and treatment in the primary care population; • Improved engagement and continuation of care if referred to more intensive levels of treatment; • Reduced demand for specialized mental health care; • High patient and provider satisfaction; • Increased likelihood of guideline-concordant care; • Improved use of antidepressants by primary care providers; • Reduced no-shows; and • Significant cost savings, by both shifting more mental health care to primary care and reducing no-shows and non-engagement rates.13 Pomerantz noted that there are challenges with this model, however, including reimbursement issues, unmet training needs, maintaining advanced clinical access, developing the evidence base for the brief interventions, and the need to consistently show that this approach results in cost savings while improving people's lives.
From page 24...
... • Improve reimbursement and credentialing for telehealth to expand access to care. • Universally adopt payment for collaborative care.
From page 25...
... . Greenfield noted that of the 30.3 million Americans who had diabetes in 2015, more than three-quarters were diagnosed -- compared to the situation for SUD and mental illness, where just more than 10 percent and 43 percent of patients, respectively, received treatment in 2018 (SAMHSA, 2019)
From page 26...
... She pointed out that one result of not building the infrastructure and workforce to effectively treat MHSUDs is that the country has been unable to respond promptly to the opioid epidemic. In 2019, the National Academies released Medications for Opioid Use Disorder Save Lives (NASEM, 2019b)
From page 27...
... These include general hospital psychiatry units that are well staffed with trained providers, specialty mental health and addiction programs, community mental health centers and addiction treatment programs, opioid treatment programs, and residential treatment centers that combine hospital- and outpatient-based care.
From page 28...
... The care model was focused on care coordination, including physical, mental, behavioral, and SUD-specific services.
From page 29...
... Reduce Implement Law Prescriber & Decrease Comprehensive Opioid MOUD/MAT and Enforcement other Stigma & Family Services Overdose other Evidence & Justice: clinician Discrimination and Supports Deaths/Nal Based Treatments Diversion to Education oxone Treatment REDUCE OUD AND OUD DEATHS POLICIES: FUNDING: CLINICAL Services RESEARCH: Legislative & Medicaid Integration among Clinical; Regulatory; Expansion; multiple levels of Implementation, State and Local Insurance – care Services Delivery Private & Medicare FIGURE 3  Treatment approaches, necessary components of care, and evidence-based policy to better address the opioid use disorder epidemic. NOTE: MAT = medication-assisted treatment; MOUD = medications for opioid use disorder; OUD = opioid use disorder.
From page 30...
... including child care, housing, and accessing treatment for comorbid physical and other mental health conditions. SOURCES: As presented by Shelly F
From page 31...
... Greenfield also recommended requiring training at all levels of provider education. This would involve training on MHSUDs for nurses, psychologists, social workers, pharmacists, physician assistants, and other professionals involved in an integrated system of care.
From page 32...
... interventions. After considering a number of possible reasons for the differences in outcomes, Shim realized that the root cause came down to the two patient populations' experiences with the social determinants of health (see Figure 4)
From page 33...
... " asked Shim. According to Shim, the differences in mental health and mental illness outcomes are inequities, not disparities.
From page 34...
... 34 FIGURE 5  Percentage of adults with no health insurance coverage by race and ethnicity. SOURCES: As presented by Ruth Shim, October 15, 2019; NCHS, 2016.
From page 35...
... Moreover, when defining essential components of care, it is important to appropriately consider the needs of the specific target population. Implementation Science and Care for Mental Health and Substance Use Disorders "Why do large health care systems implement change?
From page 36...
... 36 FIGURE 6  Percentage of Americans saying they have been personally discriminated against when going to a doctor or a health clinic because of their race, ethnicity, gender, or LGBTQ identity. NOTE: LGBTQ = lesbian, gay, bisexual, transgender, queer/questioning.
From page 37...
... She added that, with this awareness, researchers can examine the impact of an investment in the social determinants of health on an individual's health and safety. Durham noted that important drivers of organizational change include the need to save money and address labor shortages.
From page 38...
... Toward that end, and with the increasing focus on suicide prevention, the VA has instituted a multi-step suicide screening process18 that Pomerantz noted eventually led to a more comprehensive suicide risk and safety planning evaluation. Abigail Wydra from the U.S.
From page 39...
... PROMISING STRATEGIES TO TRANSLATE KNOWLEDGE INTO PRACTICE AND MONITOR IMPLEMENTATION Opening the workshop's third session, moderator Anita Everett, the director of the Center for Mental Health Services at SAMHSA, noted that her agency has addressed the challenge of improving care for individuals with MHSUDs by breaking it down into three components: 1. The "front door problem," which focuses on the problem of increasing access to care; 2.
From page 40...
... Implementation science, she explained, is about making sure that people are receiving care and treatment approaches that have been demonstrated to work in the community to move the needle in health and mental health. Beidas explained that implementation science is the scientific study of methods to promote systematic uptake of proven clinical treatments, practices, and organizational and management interventions into routine practice, and hence to improve health (Eccles et al., 2012; Grimshaw et al., 2012)
From page 41...
... . The task forced developed five key components to support implementation of evidence-based practices (see Figure 7)
From page 42...
... Beidas explained that over the course of 5 years, the use of cognitive behavioral therapy increased 6 percent, and for each additional evidence-based practice initiative the clinicians participated in, self-reported use of cognitive behavioral therapy techniques increased by 3 percent. While these numbers seem small, Beidas said that a 6 percent change in a very large system that treats 30,000 children and families can be meaningful.
From page 43...
... Beidas noted that implementation efforts must go beyond training and consider interventions to address organizational factors. Evidence-based practices will not be a panacea for addressing infrastructural challenges that require greater investments in the community health system.
From page 44...
... To better understand the available data, over the past two decades, C ­ horpita and his team have coded more than 2,400 treatments for hundreds of features, allowing them to identify 30–40 common elements among effective treatments. Chorpita noted that this helps to reduce and filter information to inform people at the point of care.
From page 45...
... "We will never know as little as we know now, because we're still discovering things every day, and we know more now than we ever did in history," he said, "so the problem of knowing everything and not knowing what to do with it is only going to get worse." Medication-Assisted Treatment and Substance Use Disorder Treatment in Primary Care Settings: A Focus on Community Health Centers Marwan Haddad is the medical director of the Center for Key Populations at Community Health Center, Inc. Founded in 1972, the center is one of the largest federally qualified health centers in the nation.
From page 46...
... Working with Community Health Center, Inc., clinics, as well as other health centers across the nation, Haddad has seen a number of different MAT 19 For more information, see https://www.centerforkeypopulations.com (accessed April 23, 2020)
From page 47...
... Other popular models include an integrated MAT clinic model, where prescribers have times and days set aside for MAT patients; the co-located model, in which MAT is prescribed in a clinic separate from primary care but prescribers could be primary care providers; the hub-and-spoke model, in which an expert hub provides inductions and a health center handles stabilization; and telemedicine models, which are starting to be deployed to deliver behavioral health and substance use treatments. Haddad identified a number of common challenges for MAT programs in primary care: • Obtaining buy-in to the program from both clinical staff and administration; • The financial cost and securing reimbursement in the context of the 15-minute clinical visit and the use of nonclinical staff, such as case managers and coordinators; • Inadequate training and expertise on addiction, harm reduction, and treating addiction as a chronic disease; • Too little time and support in the face of competing priorities; • The inability to use information technology efficiently to look at quality measures and engage in quality improvement activities; • Not knowing how to deal with polysubstance use, which is linked to a lack of understanding and training on addiction and SUD; • Fear of diversion (the idea that patients will try to deceive providers)
From page 48...
... Haddad also explained that Community Health Center, Inc., has implemented a buprenorphine dashboard that will help with quality improvement initiatives. Dealing with polysubstance use requires training and involving behavioral health professionals as true partners in a patient's care in the primary care setting.
From page 49...
... • The business of medicine. • Make screening, prevention, and • The lack of social and political treatment part of the uniform data system will to effectively address social measures for community health centers determinants of health.
From page 50...
... "We thought there were good metrics, but we did not think these metrics gave the practices enough information," said Melek. To address that issue, he and his team included cost and use in the quarterly practice reports that incorporated information such as per member per month cost by service category (e.g., ambulances, emergency services, hospice, home health care, inpatient/outpatient hospitals, skilled nursing facilities)
From page 51...
... Melek shared that for the first cohort of 100, primary care practices and the community mental health centers combined saved $47 million in the first year and $114 million in the second year. The results from the second cohort were not as positive, which Melek attributed to the fact that the practices selected for the first cohort were well prepared and ready to transition to an integrated care system, whereas subsequent cohorts needed more help transforming their practices.
From page 52...
... who, in theory, could treat more than 4 million people -- or about twice as many people with OUD. In his opioid treatment program, about 28 percent of the patients are misusing buprenorphine, which he said is a reason to be cautious about instituting a new policy at a desperate moment that might have unintended consequences.
From page 53...
... Participants first discussed challenges to engaging patients and families in person-centered care and shared decision making, such as • A lack of big ideas about how to move health care toward interprofessional collaborative care beyond the i ­mmediate care team; • Transportation challenges and access to care; • Financial and reimbursement structures; • Stigma and biases related to race, culture, socio­ conomic e status, and environment; • The limited duration of the clinical encounter; • Lack of education and health literacy; • Variable resources in underserved rural and urban care settings; and • Lack of research using implementation science. Participants also discussed many potential approaches to addressing these challenges, including • Improving clinician training on communication, active listening, language, and patience; • Teaching medical students about addiction and recovery; • Building trust on the part of the individual patient, clini cian, or care team; • Improving comparative effectiveness data to drive health care transformation; • Using a patient advocate to translate medical language, reduce jargon, and help clinicians understand cultural differences; • Using person-centered language; • Enlisting public health services to assist in educating people about the value of behavioral health care; continued
From page 54...
... , approaches to implement those compo nents across diverse care settings, and ways to monitor and scale implementation. Participants discussed components of essential care, such as • Screening and assessment for MHSUDs in primary care settings; • Measurement-based care and symptom monitoring; • Addressing the social determinants of health; and • Improved patient engagement and active listening on the part of clinicians, and disease-specific care components.
From page 55...
... " he asked. If so, that would not be a bad thing, as long as the goal is less about saving health plan dollars and more about saving the cost to society from untreated mental illness or SUDs.
From page 56...
... USING DATA TO IMPROVE CARE SERVICE DELIVERY AND PATIENT OUTCOMES To open the second day of the workshop, the session highlighted innovative practices to facilitate and optimize data collection, integration, and use. Alegría explained that this session would examine how to effectively use data to provide the most beneficial services.
From page 57...
... . The rate of opioid deaths, driven primarily by prescription opioids, remained fairly stable from 2000 to 2010, described Bernson, but deaths started rising in 2010, driven by an influx of heroin, which is less expensive.24 Bernson noted that the current fentanyl-driven third wave of the c ­ risis, where overdose deaths have grown exponentially since 2015, has caused opioid-related overdose deaths in Massachusetts to reach twice the national average.
From page 58...
... 58 1,800 1,600 1,710 1,400 1,200 1,362 1,000 800 961 Number of deaths 600 742 660 642 622 638 656 614 525 575 560 400 506 514 379 Wave 3: Fentanyl 200 Wave 1: Prescription Opioids Wave 2: Heroin and Synthetics 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 FIGURE 8  Opioid-related overdose deaths in Massachusetts. SOURCES: As presented by Dana Bernson, October 16, 2019; Massachusetts Department of Public Health: mass.gov/dph (accessed January 14, 2020)
From page 59...
... Going forward, Bernson's team is expanding the data warehouse to address not only the opioid crisis but other important public health issues, including disparities in maternal and child health care. The health department is also adding data to look at the intersection of infectious diseases and the opioid epidemic and data on the social determinants of health to better understand pressing issues, such as food insecurity and housing instability in the state.
From page 60...
... She added that "I think it is a great way to highlight how we can actually see data directly relate to policy change and outcomes." Advances in Mental Health Measurement Robert Gibbons, the Blum-Riese Professor of Biostatistics in the Departments of Medicine and Public Health Sciences and the director for the Center for Health Statistics at the University of Chicago, opened his presentation by pointing out that a new approach to screening and measurement of mental health disorders, SUDs, and suicidality can dramatically increase the precision of measurement, eliminate the clinician's burden of measurement, and decrease the burden to a particular individual. Given the power of the Internet and today's computers, it would be possible, Gibbons added, to screen the entire U.S.
From page 61...
... Gibbons described how he and his collaborators developed the CATmental health (CAT-MH) suite of nearly 15 computerized adaptive tests based on multi-dimensional item response theory.
From page 62...
... • The CAT-MH can be fully integrated into the electronic health record, and Gibbons's team has developed clinical workflows for integrated behavioral health and primary care practices and clinics. Gibbons and his collaborators have also developed the first computerized adaptive diagnostic scale, which takes 36 seconds to administer and achieves a sensitivity and specificity nearly matching that of an hour-long, face-to-face diagnostic interview (Gibbons et al., 2013)
From page 63...
... The instrument is also being validated for autism spectrum disorder in children. In closing, Gibbons listed a few example applications of CAT: • Screening 1.8 million Los Angeles residents to develop a registry of 100,000 patients, • Surveying the state of Indiana for SUD, • Perinatal depression screening and follow-up at the NorthShore University HealthSystem, and • Large-scale national survey of prevalence of mental illness and SUD in the U.S.
From page 64...
... In this way, approximately two-thirds of patients could be cared for routinely in primary care, with the remainder requiring additional assistance and education or referral to specialty care. To implement this approach, Reiss-Brennan explained, she and her colleagues examined the lived experiences of people trying to care for patients and family members suffering with mental health and social issues in the context of primary care.
From page 65...
... The answer, she said, is that implementation is difficult and requires intensive human resources. Reiss-Brennan's team found that integrating mental and physical health through primary care teams resulted in better clinical outcomes and lower costs.
From page 66...
... The model engages patients in care planning beginning at the hospital and provides them with communitybased care management after discharge from the hospital that includes home visits and medicine reconciliation and accompaniment to primary care and specialist visits within 7 days of hospital discharge (Noonan and Craig, 2019)
From page 67...
... a realtime, vendor-managed health information exchange; (2) a user-customizable, Mental Food Access & Health Nutrition Education Provider Relationship Reproductive Health ID Medication & Medical Supplies Family & Peer Health Relationships Management Advocacy Addiction & Activism Legal Benefits & Entitlements Transportation Housing Other FIGURE 9  The Camden Coalition's 16 domains of care to engage individuals in bedside care planning.
From page 68...
... Thirteen practices in the city, including sole practitioners, federally qualified health centers, and health-system-affiliated practices pledged to open appointment slots for patients recently discharged from the hospital. Evaluation of this initiative found that patients who connected with primary care within the 7 days had fewer 30- and 90-day readmissions compared to similar patients with a later or no primary care appointment (Wiest et al., 2019)
From page 69...
... She also shares the data use agreements her team had developed to guide other state health departments. Colleen Barry from Johns Hopkins University asked Reiss-Brennan how one can take the lessons learned from her work at Intermountain -- a unique delivery system -- and use them to inform individual primary care providers ­ within the community or smaller systems that are not as well equipped 29 For more information, see https://www.latimes.com/local/education/higher-ed/la-pol ca-community-college-homeless-students-20190307-story.html (accessed April 23, 2020)
From page 70...
... Barry also asked Reiss-Brennan if there were lessons from Inter­ ountain's m work on mental health that could be related to treating SUDs in primary care. Reiss-Brennan responded that Intermountain treats SUDs as one of its chronic diseases, and so it screens patients for substance use and social determinants.
From page 71...
... Addressing the suicide epidemic will require education and building awareness throughout the entire population about what is happening, what its causes are, and what can be done in the community to prevent suicide, she added. Pomerantz, referring to the one-sixth of Intermountain's primary care patients who need specialty mental health services, asked Reiss-Brennan how the health system keeps those individuals connected to primary care given that they are also at the highest risk for negative health outcomes beyond their mental illness.
From page 72...
... Published in 2018, these projections32 include psychiatrists, psychologists, several types of counselors and therapists, social workers, and select primary care providers. The key finding of this analysis was that barring major shifts in the use of behavioral 31 For more information, see https://www.fda.gov/regulatory-information/selected amendments-fdc-act/21st-century-cures-act (accessed December 3, 2019)
From page 73...
... "Unfortunately, this is not uncommon for health care occupations," said Washko, "and it is perhaps more a factor of complex socioeconomic determinants that push and pull an individual to live and work in a given geographic area." As a result, she said, building, redistributing, and reshaping the behavioral health workforce must be aligned with other efforts to address the social determinants of health and improve overall delivery of mental health and SUD services. Toward that end, the behavioral health field must move toward improved coordination and integration with not only primary care but specialty emergency and rehabilitation care settings.
From page 74...
... . Holloway explained that these data were useful for assessing the difference between those who were engaged in SUD treatment full time versus part time and between professions such as psychiatric nurse practitioners and physician assistants (Bauer and Groneberg, 2016; Kanuganti et al., 2016; McGrail, 2012)
From page 75...
... Nurse Care Manager Model for Office-Based Addiction Treatment Colleen LaBelle, who oversees Office-Based Addiction Services at the Boston Medical Center, provided her perspective on the nurse care manager model for office-based addiction treatment. She explained that it began at 33 The two-step floating catchment area method was developed to measure spatial ­ ccessibility a to primary care physicians.
From page 76...
... LaBelle explained that when Massachusetts saw how effective this pilot program was at getting patients into and retaining them in treatment (Alford et al., 2011) , it funded community health centers across the state to adopt this program with training and technical assistance from LaBelle and her colleagues.
From page 77...
... 12.7% Program 6.2% 6.7% 4.8% % of patients in STATE OBAT 2.8% 1+ night detox 1+ night inpatient hospital 1+ ED FIGURE 10  Health care utilization outcomes at Massachusetts nurse care manager sites for office-based addiction treatment. NOTE: ED = emergency department; OBAT = office-based addiction treatment.
From page 78...
... When considering how to address workforce shortages, LaBelle believes that nurse practitioners and physician assistants will be a big part of the solution, particularly given the trend of fewer physicians entering into and remaining in primary care, especially in community health centers and rural areas. She noted there have been legislative efforts to try to standardize nurse practitioners' ability to practice independently, as this further creates ­ arriers b to treatment.
From page 79...
... She also found that ongoing support was essential to staff retention. To continue developing the workforce for integrated care, LaBelle supports allowing all providers to work to the scope of their practice, having treatment on demand wherever patients present, using community health centers, telehealth, nurses, and pharmacists to expand treatment, educating and engaging champions, and removing all barriers to care.
From page 80...
... Social workers at the VA exercise a range of clinical skills, starting with identifying high-risk veterans who may experience adverse health outcomes related to social determinants of health or other barriers to care. They also complete a clinical assessment of a veteran's biopsychosocial situation, including MHSUDs, and screen for a variety of mental health conditions, including PTSD and suicide risk.
From page 81...
... Taylor added that given their whole-health approach to care, social workers are uniquely qualified to address these aspects of care and are vital members of health care delivery and integrated care teams. "We have to expand our traditional health care delivery model to include behavioral health and the social determinants of health," she concluded.
From page 82...
... Department of Labor, which ruled in 2018 that peer supporters were not significantly different than community health workers. His organization was told that to become a formally identified profession, there must be at least 25,000 individuals in the United States in that profession.
From page 83...
... 2010. Expanding access to hepatitis C virus treatment -- Extension for Community Healthcare Outcomes (ECHO)
From page 84...
... Implementation Science 14(1)
From page 85...
... 2019. Social determinants and military veterans' suicide ideation and attempt: A cross-sectional analysis of electronic health record data.
From page 86...
... 2019. Without wasting a word: Extreme improvements in efficiency and accuracy using computerized adaptive testing for mental health disorders (CAT-MH)
From page 87...
... :510–520. NAMI (National Alliance on Mental Illness)
From page 88...
... 2019. Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: Evidence from a national survey.
From page 89...
... 2010. Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics?
From page 90...
... https://www.who.int/mental_health/evidence/excess_mortality_meeting_report.pdf (accessed February 7, 2020)


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