In-depth Evaluation Helps Advance the Integration of Behavioral Health at Maine Health Clinics and Beyond

The Maine Health Access Foundation (MeHAF) believed in the value of integrating behavioral health and primary care services to create a more holistic, patient-centered approach to health care. To this end, MeHAF established a major, 12-year, $14 million grant program to help transform the health system in Maine. MeHAF needed an objective analysis to ascertain that its money had the intended impact, and hired JSI.

JSI’s goal was to answer MeHAF’s fundamental question for this complex project: “Is our investment making a difference?” Are services reaching people and are services making them better? Are the 88 settings—primary care practices, community mental health centers, and hospitals—and hundreds of staff providing high quality services? What is working and what is not working for staff and their patients? JSI and MeHAF also wanted the knowledge gained through this program to contribute to lasting change among health care providers in the state and beyond.

JSI Makes a Difference

Using our past experience researching integrated behavioral care and performing multi-setting evaluations, JSI designed and implemented an evaluation that would meet MeHAF’s goals. A solid evaluation design can help make sense of complex situations by being a roadmap to systematically organize information. The evaluation design encompassed quantitative enrollment data and qualitative assessments of integration collected by all organizations; patient outcome measures tailored to each organization, and a series of structured interviews and site visits to capture the nature of every program and its barriers and success to integration. We monitored the quality and content of the data collected, interpreted the information, and fed it back to MeHAF and participating organizations, so they could assess the quality of their programs. JSI also provided technical assistance to local organizations to strengthen their own monitoring and evaluation capability.

JSI’s Evaluation Work includes:

• Established the reach of the program by cataloging behavioral health needs, assessing market penetration, and profiling patient demographics.
• Portrayed key features of successful/not-successful integration using the Realist Framework’s easy-to-understand diagrams.
• Developed a method to estimate the change in the degree of organizational integration over time.
• Identified innovative models, documented in case studies.

Results

Ultimately, JSI’s major contribution was to inform MeHAF that their investment did, in fact, lead to a substantial portion of the population receiving services, that those served were more diverse than the state as a whole. It also identified key features of successful and/or innovative programs. This information helped MeHAF refine its investment strategy and advocate for further integrative services, such as in Patient-Centered Medical Homes.

MeHAF is a leader in health care reform, and was eager to see a wide reach and lasting change. JSI added value by helping MeHAF disseminate the evaluation findings to benefit other entities that are enmeshed in the fast-moving environment of integrated health. JSI and MeHAF shared the findings through:

Three case studies described strategies used by diverse organizations to engage patients at each level of health care decision making:

• Practical Strategies to Engage Patients with Integrated Health Care
• Making Wellness Part of the Equation for Life

This body of objective data is a boon to health care reform. MeHAF, with the help of JSI’s evaluation, has laid the groundwork for policy change for advancement in integrating behavioral health care across clinics and providers within the state and outside the state.

The JSI team’s collaborative approach and tailored, hands-on technical assistance was key to success. JSI also brought significant experience, having provided evaluation assistance on a similarly large complex behavioral integration project involving a different population type.

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Additional Resources

Learn more from the Overview slide show and final report for effective presentation of the client’s accomplishments.

Two articles summarizing findings and providing context:

• How Integrative Care Improves Life for Nursing Home Patients With Mental Health Diagnoses
• Making Wellness a Part of the Mental Health Equation for Life

This program was also noted in a Health Affairs blog, Advancing Integrated Behavioral Health Care In Texas And Maine: Lessons From The Field.

Two National Conference Presentations:

• Optimizing the Probability of Successful Integration Implementation. Grantham SM, Coakley E, McKinney A, Truesdell N, Ward M, Hayes-Boober B, Leonard B. Collaborative Family Healthcare Association Conference, Denver, CO (October 2013).
• Integrated Behavioral/Physical Health: A Realist Approach. Grantham SM, Coakley E, McKinney A, Truesdell N, Ward M, Hayes-Boober B, Leonard B. Poster. 4th Annual NIH Conference on the Science of Dissemination and Implementation (March 2011).

Book chapter: Grantham SM, Boober BH, McKinney A, Truesdell NM, Coakley E, Ward M. Working Toward Collaborative Care. Borkowski, N and Deckard, G eds. Organizational Behavior in Healthcare: Case Studies. 2013. Jones and Bartlett Publishers.