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Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

There are several factors that contribute to the health and quality of life for individuals, families and communities such as preventive services, safe and healthy environments, access to affordable physical and behavioral healthcare. Unfortunately these services are usually not well integrated or provided within a collaborative framework. However, changes in the healthcare systems are creating new opportunities to build a framework for integration. Moving the concept of integration forward is a complicated task that will involve several activities. The SHIP Integration Priority is developed to achieve several goals towards this effort.

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Story Behind the Curve

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

For this SHIP goal, several activities were planned for implementation:

  • Analyze health data from clinics with healthcare home models, and recommend best practices.
  • Implement health education and promotion programs to compliment clinic services.
Why Is This Important?

The health care home model (also referred to as the medical home model) has the potential to improve health care delivery at the patient level by redesigning and improving the linkage between primary care clinics and public health agencies. The Health Care Home Model (HCHM) was first implemented in the 1960s, but it has gained considerable momentum in the 2000s. Although not all HCHMs are successful, several research studies have found that these models can improve the quality of health care services, reduce costs, and improve the health of the population.

In Nebraska, the model is rapidly spreading across the state. In 2011, Blue Cross Blue Shield of Nebraska initiated a medical home model in nine cities by focusing on management of diabetes, using test results for the patient’s blood sugar, blood pressure, and cholesterol levels. In 2012, this model was expanded to 33 clinics and about 42,000 Blue Cross subscribers.

In 2010, the State Legislature appropriated funds for two medical home pilot projects for Medicaid patients. In 2011, two pilot projects were launched in clinics located in Lexington and Kearney. Also, as part of the Medicaid managed care contract, Coventry and Arbor Health are expected to develop medical home models in twelve new communities over a three-year period. Blue Cross Blue Shield of Nebraska has experienced early success with this model and the Medicaid program is rigorously evaluating the results of the pilot projects.

The HCHM has the potential to improve the health of the population by improving access to care (e.g., after hours care and electronic communication), and reducing health disparities. For example, racial and ethnic minority populations tend to have a higher incidence of chronic conditions, which could be treated more effectively through more timely clinical preventive services (e.g., culturally and linguistically relevant diabetes health education). Other disparities can be prevented through cancer screening programs and immunizations.

Public health agencies can provide direct support to HCHMs and they can improve the health of the population by working collaboratively with employers, schools, the faith community, and nonprofit agencies. They also provide a variety of programs and activities that are designed to reach the entire population.

How We Impact

The Health Care Home Model has some very unique characteristics and places patients at the center of the health care system and includes the following:

  •  A physician-led, team-based coordination of care process that focuses on the patient and his/her family.
  •  A care model that is holistic – including the patient’s physical, mental, and socioeconomic health status.
  •  A care model where each patient is assigned a provider and care team that oversees and implements continuity of care that is delivered through access to a spectrum of health care delivery services, including home health, hospital inpatient care, specialists, rehabilitation facilities, and long-term care facilities.
  •  A focus on providing high-quality care, especially to patients with chronic disease/conditions, including a documented monitoring process using patient registries.
  •  24/7 access to care.

There are several elements of the health care home model. These elements include 1) patient tracking and registry, 2) access to care, 3) care management, 4) patient self-management support, 5) test tracking, 6) referral tracking, 7) performance reporting improvement, and 8) advanced electronic communication.

What Works

Several clinics are already operating healthcare home clinics and tracking various health indicators such as Hemoglobin A1c and cholesterol levels. These clinics receive additional funding from BlueCross BlueShield of Nebraska, Medicaid, and Federally Qualified Health Centers (FQHCs). By developing a pilot project and collecting comparable data among selected clinics, it will be possible to identify best practices and to identify the roles of local and state health departments in tracking the data and connecting patients with appropriate community health promotion programs.

Definition

This scorecard is created to track performance, therefore the demonstration of data (numerical and narrative) describes what we define as success. In some instances, a trend may be moving in the wrong direction, but still may be within our 'Target for Success' area. The use of Color Arrows (and sometimes also Color Bands) help to define the Target for Success and Current Progress.

Green, Black and Red color arrows are used to reflect our 'Current Progress' status.

  • GREEN Arrow = We're getting better!
  • BLACK Arrow = We're maintaining our position.
  • RED Arrow = We're going in the wrong direction.

Green, Yellow or Red color bands are used to reflect our 'Target for Success' zones.

  • GREEN Color Band = We've reached our Target for Success!
  • YELLOW Color Band = We're making progress, but not quite there yet.
  • RED Color Band = We're below our Target for Success.

Data is described with the Time Period, Actual Value, Target Value, Current Trend and Baseline Change %. These mean:

  • Time Period - The most current time period for which the data were available.
  • Actual Value - The actual level of achievement, the most current data point for the indicator; also shown in a Color Band to reflect if that value is or is not within our Target for Success zone.
  • Target Value - The desired level of achievement for the data indicator.
  • Current Trend - The direction of progress is shown by a Color Arrow to reflect our Current Progress status, and also noting for how many data points the direction been occurring.
  • Baseline Change % - The percentage of change between the baseline data point and the current data point (actual value); also shown with a Color Arrow to describe Current Progress status.
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Time Period
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Story Behind the Curve

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

This SHIP goal includes several activities that were planned for implementation:

  • Local health departments complete community health needs assessments in collaboration with local hospitals.
  • Local health departments implement community health improvement plans in collaboration with local hospitals.
Why Is This Important?

The Affordable Care Act requires all nonprofit hospitals to complete a population-based community health needs assessment and an implementation plan based on the priorities in the Community Health Needs Assessments (CHNA). Currently, many hospitals are working with local health departments to develop the CHNA and the implementation plan. Since these plans must be developed every three years beginning in 2013, it is a great opportunity to expand the resources for population health activities.

The activities and programs of the local public health departments are organized under the three core functions of public health: assessment, policy development, and assurance. The assessment function involves the collection and analysis of information to identify important health problems. Policy development focuses on building coalitions that can develop and advocate for local and state health policies to address the high priority health issues. The assurance function makes state and local health agencies as well as health professionals responsible for ensuring that programs and services are available to meet the identified priority needs of the population.

How We Impact

The activities and programs of the local public health departments are summarized under the associated ten essential services of public health. The ten essential services of public health provide a working definition of the public health system and a guiding framework for the responsibilities of local public health partners.

1. Monitor Health Status to Identify and Solve Community Health Problems

2. Diagnose and Investigate Health Problems and Health Hazards in the Community

3. Inform, Educate, and Empower People about Health Issues

4. Mobilize Community Partnerships to Identify and Solve Health Problems

5. Develop Policies and Plans that Support Individual and Statewide Health Efforts

6. Enforce Laws and Regulations that Protect Health and Ensure Safety

7. Link People to Needed Medical and Mental Health Services and Assure the Provision of Health Care when Otherwise not Available

8. Assure a Competent Public Health and Personal Health Care Workforce

9. Evaluate Effectiveness, Accessibility, and Quality of Services within the Health Care Industry and Public Health Departments

10. Research and Gain New Insights and Innovative Solutions to Health Problems



What Works

Over the past thirteen years, all eighteen local public health departments have conducted a comprehensive community health assessment and have repeated the process at least once every five years. A majority of the departments use the Mobilizing for Action through Planning and Partnerships (MAPP) approach to update their local public health improvement plans approximately every five years. This process involves a thorough review of health needs, community health risks (e.g., tobacco use, obesity levels, and environmental quality), and the ease of access to health services (e.g., insurance coverage status, transportation). This process also involves input from a diverse group of community members and the development of local health priorities. Above to the left is a statewide breakdown of the local health departments in Nebraska. Below is a graphic depicting the MAPP process by which the state and some local health departments identify health priorities and formulate health goals.

Click here to learn more about the MAPP process: http://www.naccho.org/topics/infrastructure/MAPP/i...




Definition

This scorecard is created to track performance, therefore the demonstration of data (numerical and narrative) describes what we define as success. In some instances, a trend may be moving in the wrong direction, but still may be within our 'Target for Success' area. The use of Color Arrows (and sometimes also Color Bands) help to define the Target for Success and Current Progress.

Green, Black and Red color arrows are used to reflect our 'Current Progress' status.

  • GREEN Arrow = We're getting better!
  • BLACK Arrow = We're maintaining our position.
  • RED Arrow = We're going in the wrong direction.

Green, Yellow or Red color bands are used to reflect our 'Target for Success' zones.

  • GREEN Color Band = We've reached our Target for Success!
  • YELLOW Color Band = We're making progress, but not quite there yet.
  • RED Color Band = We're below our Target for Success.

Data is described with the Time Period, Actual Value, Target Value, Current Trend and Baseline Change %. These mean:

  • Time Period - The most current time period for which the data were available.
  • Actual Value - The actual level of achievement, the most current data point for the indicator; also shown in a Color Band to reflect if that value is or is not within our Target for Success zone.
  • Target Value - The desired level of achievement for the data indicator.
  • Current Trend - The direction of progress is shown by a Color Arrow to reflect our Current Progress status, and also noting for how many data points the direction been occurring.
  • Baseline Change % - The percentage of change between the baseline data point and the current data point (actual value); also shown with a Color Arrow to describe Current Progress status.
What We Do

While many local health departments collaborate to make Nebraska healthier, here is an example from the Northeast Nebraska Public Health Department:

The Northeast Nebraska Public Health Department (NNPHD) built community partnerships through the Mobilizing for Action through Planning and Partnerships (MAPP) process in 2007 and again in 2011-2013. This process includes data collection from every known data set for public health, hospitals, community action agencies, educational institutions, local and regional governmental entities and other non-governmental organizations. The NNPHD and the two Critical Access Hospitals located within the health district, Pender Community Health Center and Providence Medical Center, combined resources, time and efforts to coordinate these work products for the betterment of the community. Other collaborations between local health departments and area hospitals in Nebraska help to improve the quality and comprehensiveness of care for a variety of health priorities. These partnerships aim to create healthier communities and subsequently aid in creating a healthier state.

Who We Serve

To learn more about how local health departments contribute to the public health system, please explore the Annual Report on the Public Health Portion of the Nebraska Health Care Funding Act (LB 692): http://dhhs.ne.gov/publichealth/Pages/puh_oph_lhd....

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Story Behind the Curve

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

For this SHIP goal, several activities were planned for implementation:

  • Develop reports documenting the recommended roles, core competencies, curriculum and systems for Nebraska community health workers.
  • Provide support to the PHAN Community Health Worker Association to implement system goals.

There has been a longstanding interest in Community Health Workers (CHWs) in Nebraska since the 1990s. While meetings about the CHW workforce were conducted by local health department leadership in 2012 – 2013, momentum to move forward and establish a CHW coalition in the state was solidified in May 2012 during the annual Nebraska Department of Health and Human Services (DHHS) Minority Health conference. Interested participants attended a session facilitated by Carl Rush, a national consultant for the American Public Health Association on CHW workforce development. Carl included review of national trends and CHW models as well as consideration of a CHW initiative for the state. Subsequently, an informal Nebraska Community Health Worker Coalition was launched that included a Steering Committee and four workgroups (Association, Standards, Education, Sustainability) that would explore issues associated with successful development of the workforce.

Momentum for more structured consideration of elevating a CHW workforce in the state was further accelerated by efforts across the nation to promote CHWs as essential members of continuity of care teams in patient centered medical home models (PCMH). PCMH is widely promoted by the Centers for Medicaid and Medicare Services as a means of achieving the Triple AIM:improving population health and health outcomes; reducing health care costs; and improving patient satisfaction with care. Coupled with national dialogues regarding the potential to have third party billing for CHW services has been a strong incentive to position states for readiness to deploy the CHW workforce.

Action Plan

Stakeholders on the Nebraska CHW Coalition Steering Committee worked collectively as a task force more than as a coalition so that one of the workgroups, the Association, could mature and assume leadership for a single statewide CHW organization led, in majority, by CHW members.The transition in leadership from the Steering Committee to the Public Health Association of Nebraska (PHAN) CHW Association section began in December 2014.In accordance with the SHIP objective, the Steering Committee delivered recommendations for core competencies and skills, a scope of practice, and certification process.Four existing training programs were evaluated for commonalities, alignment of curricula with skills base and scope of practice, differences, strengths,and costs in terms of time and fees.The Steering Committee provided a “living will” to the PHAN CHW Association that included key items to carry forward from the Steering Committee action plan.

Click here to learn more about the PHAN Community Health Worker Association: http://publichealthne.org/phan-sections/community-...

Why Is This Important?

By definition, Community Health Workers are unique and essential members of the health care team. A CHW is an individual who:

  • Serves as a liaison/link between public health, health care, behavioral health services, social services, and the community to assist individuals and communities in adopting healthy behaviors
  • Conducts outreach that promotes and improves individual and community health
  • Facilitates access to services, decreases health disparities, and improves the quality and cultural competence of service delivery in Nebraska.

A CHW is a trusted member of, or has a good understanding of, the community they serve.They are able to build trusting relationships and are able to link individuals with the systems of care in the communities they serve.As recognized members of the communities they serve creates a unique and powerful bond of affinity and capability to communicate effectively with individuals and families seeking health care.

A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy.

Partners

The Nebraska Community Health Worker Coalition Steering Committee was comprised of stakeholders engaged in varied aspects of CHW workforce development: funders, state and local health departments who employed CHWs, hospitals that employed CHWs, college or university staff involved with CHW training and “curriculum development, private sector CHW employers, state health department program staff, Public Health Association of Nebraska, state and local level policy advocates, a tribal health director, etc.

What Works

The Nebraska CHW Steering Committee reviewed national literature extensively in itsefforts to capitalize on lessons learned from Massachusetts, Minnesota, New York, Texas, Oregon; collective initiatives coordinated by the American Public Health Association (APHA), and the Indian Health Service. At the heart of workforce development was a sense creating a successful process for Nebraska that gives particular consideration to the concern for the unique needs of CHWs and CHW employers.

Two Nebraska models are in place in which hospitals are using CHWs in Clinical Integrated Networks to establish measures that demonstrate improved patient outcomes and savings.

In Kearney, NE Sentinel Health has partnered with Good Samaritan Hospital and a local clinic to create a network that uses CHWs. In its third year, the program has shown a61% reduction in Emergency Room visits from 313 visits to 123 visits. For clients enrolled in the program for one complete year), there was a 46% reduction in the total Emergency Room cost ($498,293 to $268,922).

In Grand Island, NE. Saint Francis Medical Center has just started a network in partnership with the privately funded Third City Community Clinic and federally funded Heartland Health Center and is using grant dollars to fund Community Health Workers. The program proposes to decrease Saint Francis Medical Center hospitalizations by at least 25% (4,622 or fewer hospital admissions); lower the rate of patient readmissions within 30 to 6.5%; reduce charity costs by 20% (annual reduction from $4.45 million to $3.56 million); and to establish 30% improvements in AC1 readings, cholesterol readings and blood pressure readings.

Additionally, the Indian Health Service (IHS) infrastructure for its community health representative (CHR) workforce has been in place since the 1960s and provides opportunities for the state to learn how IHS has addressed challenges successfully in building and implementing this profession.There are four tribes located in Nebraska (Winnebago Tribe of Nebraska, Ponca Tribe of Nebraska, Santee Sioux Nation, and Omaha Tribe of Nebraska) that have a combination of IHS and tribally owned health care facilities.IHS has also had in place for a number of years the Improving Patient Care (IPC) model which is built on a foundation of the Patient Centered Medical Home Model (PCMH) in development nationally.

Definition

This scorecard is created to track performance, therefore the demonstration of data (numerical and narrative) describes what we define as success. In some instances, a trend may be moving in the wrong direction, but still may be within our 'Target for Success' area. The use of Color Arrows (and sometimes also Color Bands) help to define the Target for Success and Current Progress.

Green, Black and Red color arrows are used to reflect our 'Current Progress' status.

  • GREEN Arrow = We're getting better!
  • BLACK Arrow = We're maintaining our position.
  • RED Arrow = We're going in the wrong direction.

Green, Yellow or Red color bands are used to reflect our 'Target for Success' zones.

  • GREEN Color Band = We've reached our Target for Success!
  • YELLOW Color Band = We're making progress, but not quite there yet.
  • RED Color Band = We're below our Target for Success.

Data is described with the Time Period, Actual Value, Target Value, Current Trend and Baseline Change %. These mean:

  • Time Period - The most current time period for which the data were available.
  • Actual Value - The actual level of achievement, the most current data point for the indicator; also shown in a Color Band to reflect if that value is or is not within our Target for Success zone.
  • Target Value - The desired level of achievement for the data indicator.
  • Current Trend - The direction of progress is shown by a Color Arrow to reflect our Current Progress status, and also noting for how many data points the direction been occurring.
  • Baseline Change % - The percentage of change between the baseline data point and the current data point (actual value); also shown with a Color Arrow to describe Current Progress status.
What We Do

Check out these videos to learn more about Community Health Workers:

Am I a Community Health Worker?

Employing a Community Health Worker

How Community Health Workers Help Community Members: Maria & Belen’s Story.


Roles (functions/responsibilities/activities) of Community Health Workers most commonly include:

  • Ability to work within the Nebraska CHW Association code of ethics
  • Serve as a Cultural Health Liaison or Facilitator
  • Empower clients through advocacy and education
  • Conduct outreach activities
  • Raise awareness of health and wellness needs
  • Provide disease prevention education
  • Provide social support
  • Build community capacity
  • Community resources navigation
Who We Serve

Community health workers have been utilized within the state for more than 20 years.They have been carrying out the roles of community health workers under the title of promotoras, lay health ambassadors, outreach workers, community health representatives in tribal communities, and interventionists to just name a few.They have been used throughout the state serving communities based on needs of service providers, including state, local, and tribal governments, community based service organizations, faith-based organizations, as well as clinics serving disparate populations such as Federally Qualified Health Centers.

Strategy

The most stable path to sustainability for Community Health Workers is to create value for Nebraska healthcare providers. However, the assumption must be made that the employers of healthcare – hospitals, clinics and physicians – are not yet convinced that the hiring of Community Health Workers will provide them with a desired return on investment, in terms of patient outcomes and cost savings.

While hospitals and physicians may be willing to invest in Community Health Workers as a best practice toward improving healthcare outcomes, they will seek documentation of its success. It is incumbent upon Community Healthcare Worker programs to carefully document improvement in patient outcomes and hospital/clinic savings to establish a cause and effect relationship between the hiring of Community Healthcare Workers and better patient outcomes. Strategies and methodologies used in reaching these outcomes also will become very important in decision-making by healthcare providers before deciding whether to invest in Community Healthcare Workers.

For the four American Indian tribes and nations located in Nebraska, it will be critical for tribal leadership to assess the value of the statewide initiative to promote the CHW workforce to each tribe as well as the PCMH model in light of the long-standing health care infrastructure provided by IHS.

As supporters of Community Health Workers in Nebraska move forward to help fulfill the Triple Aim Vision, important issues need to be considered:

  • Certification as opposed to licensure and credentialing. Based on lessons learned from other states, certification appears to be the right fit to provide CHWs with a defined role in healthcare but also flexibility to meet the needs across the state.
  • In the development of payer Sources, it is important to consider the role of Behavioral Health Specialists in working with CHWs to develop successful client and patient outcomes. A significant individuals fail at self-care because of anxiety and depression.
  • Community Health Worker standards should be kept separate from Workforce development to protect the integrity of the CHW role and position within the overall healthcare picture.
  • Integrated care opportunities will exist for CHWs. It will become important for CHWs to understand their specific responsibilities and how they fit within the healthcare system. CHWs will be able to specialize in certain types of care but will also need to remain within their own scope of skill sets and responsibilities.
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Time Period
Current Actual Value
Current Trend
Story Behind the Curve

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

For this SHIP goal, several activities planned for implementation:

  • Complete a list of public health programs and strategies to implement in clinics with a healthcare home model.
  • Implement public health programs in clinics with healthcare home models.
Why Is This Important?

To improve the health of individual patients and the population of the community as a whole, it is essential to connect community-based population heatlh programs with healthcare home clinics. The first step is to identify evidence-based programs and connect them with patients who receive care in healthcare homes. In many areas, these programs will need to expand their reach across the state.

There are many opportunities for HCHs to work together with public health agencies and their community partners. In fact, improving the individual health of patients will depend to a great degree on what improvements are made in the health of the population. When HCHs and public health agencies work together, both goals can be achieved. Although the role of public health agencies will certainly evolve over time, they are in an ideal position to directly assist HCHs and to engage a wide array of community-based partners.


The Practical Playbook is another valuable resource about public health and primary care integration: https://www.practicalplaybook.org/


How We Impact

Public health agencies and their community partners can play a vital role in the success of the HCHM. In the area of patient tracking and registry, public health staff with their data analytic expertise and understanding of disease patterns can assist staff from smaller primary care clinics in interpreting the data to obtain more meaningful results. Currently, staff from the Division of Public Health are working with three rural primary care clinics to help them better understand the registry data and answer questions about the best practices for controlling cholesterol and hypertension.

Using data from the state, regional, or national health information exchanges, public health staff will eventually be able to conduct population-based studies based on the analysis of aggregated patient registry data. For example, they will be able to assess if the treatments of patients with diabetes and hypertension have been effective.

Under access to care, public health can assist HCHs in facilitating enrollment in health insurance, developing transportation options, and providing some direct clinical preventive services such as immunizations and home visits for new mothers.

In care management, health education and health promotion programs are already being implemented to address several high risk behaviors and problem areas (e.g., physical inactivity, poor nutrition, tobacco and alcohol use, timely prenatal care, and domestic violence) associated with cardiovascular disease, cancer, and mental health. These programs can reinforce the messages that are provided by clinic staff. For example, many local health departments are using media campaigns and other programmatic activities to encourage all adults over 50 to get screened for colon cancer or to stop smoking.

Definition

This scorecard is created to track performance, therefore the demonstration of data (numerical and narrative) describes what we define as success. In some instances, a trend may be moving in the wrong direction, but still may be within our 'Target for Success' area. The use of Color Arrows (and sometimes also Color Bands) help to define the Target for Success and Current Progress.

Green, Black and Red color arrows are used to reflect our 'Current Progress' status.

  • GREEN Arrow = We're getting better!
  • BLACK Arrow = We're maintaining our position.
  • RED Arrow = We're going in the wrong direction.

Green, Yellow or Red color bands are used to reflect our 'Target for Success' zones.

  • GREEN Color Band = We've reached our Target for Success!
  • YELLOW Color Band = We're making progress, but not quite there yet.
  • RED Color Band = We're below our Target for Success.

Data is described with the Time Period, Actual Value, Target Value, Current Trend and Baseline Change %. These mean:

  • Time Period - The most current time period for which the data were available.
  • Actual Value - The actual level of achievement, the most current data point for the indicator; also shown in a Color Band to reflect if that value is or is not within our Target for Success zone.
  • Target Value - The desired level of achievement for the data indicator.
  • Current Trend - The direction of progress is shown by a Color Arrow to reflect our Current Progress status, and also noting for how many data points the direction been occurring.
  • Baseline Change % - The percentage of change between the baseline data point and the current data point (actual value); also shown with a Color Arrow to describe Current Progress status.
R
Time Period
Current Actual Value
Current Trend
Story Behind the Curve

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

For this SHIP goal, several activities were planned for implementation:

  • Complete a report outlining opportunities and recommendations to integrate public health and mental health/substance abuse.
Action Plan

The principal goal of this project was to identify areas of opportunity to address behavioral health within the spectrum of Nebraska’s public health system, and how integrative approaches are applicable. The University of Nebraska Public Policy Center facilitated a study and produced a final report summarizing the components of the study, and outlining a series of recommendations to obtain that goal. There were four components of the study:

1. Perform an environmental scan of the primary care, public health and behavioral health landscape to identify opportunities for connections between policies, practice and partners. The environmental scan includes an inventory of Nebraska public health and behavioral health practices/programs to identify opportunities for connections. To help in organizing the initiatives, a conceptual framework for integration was developed and can be found in Appendix A. The environmental scan can be found in Appendix B along with a list of individuals interviewed as part of the scan.

2. Perform a review of literature, studies, policies, practices or programs to identify examples of activities and strategies that could be considered to promote and support integration within Nebraska’s public health, primary care and behavioral health environment. The literature review can be found in Appendix C.

3. Facilitate workgroup meetings to engage partners within primary care, public health and behavioral health in the study of integration opportunities in Nebraska. The workgroup provided oversight for a) the environmental scan report and practices review report; b) discussion of possible roles and responsibilities of public health and behavioral health integration; c) consideration of opportunities to progress and prioritizing key strategies to further review; d) compilation of a final report summarizing findings and recommendations for Nebraska.

4. Prepare a final report summarizing the discoveries and recommendations from the scan, review and workgroup process.

A final report was published in September 2015.

Why Is This Important?

There is sufficient evidence to indicate that both children and adults who suffer from mental health and substance abuse problems are also more likely to have a great prevalence of unhealthy behaviors. Integrating efforts across public health, behavioral health and primary care has the potential to improve quality of life and produce economic benefits throughout the state. Making healthcare, including behavioral healthcare, a priority will improve the health and happiness of individual Nebraskans, improve the income and wellbeing of families, enhance community living, accelerate educational achievement, and elevate Nebraska’s businesses and economy. Public health has an important leadership role in creating this vision of whole-health and facilitating a cross-system approach toward achieving this vision. Achieving this goal will require visionary leadership through executive and legislative commitment to make this effort one of the highest priorities of the State.

Although state and local public health agencies have implemented or partnered to implement and integrate some mental health and substance abuse programs, the future role of these agencies is unclear as more emphasis on integration approaches is encouraged. A study to consider the current environment and provide recommendations as well as opportunities for collaborative relationships is likely to be of benefit.

Definition

This scorecard is created to track performance, therefore the demonstration of data (numerical and narrative) describes what we define as success. In some instances, a trend may be moving in the wrong direction, but still may be within our 'Target for Success' area. The use of Color Arrows (and sometimes also Color Bands) help to define the Target for Success and Current Progress.

Green, Black and Red color arrows are used to reflect our 'Current Progress' status.

  • GREEN Arrow = We're getting better!
  • BLACK Arrow = We're maintaining our position.
  • RED Arrow = We're going in the wrong direction.

Green, Yellow or Red color bands are used to reflect our 'Target for Success' zones.

  • GREEN Color Band = We've reached our Target for Success!
  • YELLOW Color Band = We're making progress, but not quite there yet.
  • RED Color Band = We're below our Target for Success.

Data is described with the Time Period, Actual Value, Target Value, Current Trend and Baseline Change %. These mean:

  • Time Period - The most current time period for which the data were available.
  • Actual Value - The actual level of achievement, the most current data point for the indicator; also shown in a Color Band to reflect if that value is or is not within our Target for Success zone.
  • Target Value - The desired level of achievement for the data indicator.
  • Current Trend - The direction of progress is shown by a Color Arrow to reflect our Current Progress status, and also noting for how many data points the direction been occurring.
  • Baseline Change % - The percentage of change between the baseline data point and the current data point (actual value); also shown with a Color Arrow to describe Current Progress status.
Strategy

The State Health Improvement Plan Initiative, particularly the goal to integrate public health and behavioral health, is a significant indicator that the State of Nebraska recognizes the value of integration. There are rich and varied integration efforts currently underway across state agencies, local public health and behavioral health agencies, private foundations, and community coalitions. However, there is no central point of collaboration and leadership tying these efforts together. The following are some recommended next steps:

1. Enhance state-level leadership for public health/behavioral health integration.

2. As part of state-level leadership, develop a common framework for whole-health care, encompassing public health, behavioral health, and primary care.

3. Address Public Health and Behavioral Health Workforce deficiencies.

4. Use data collected by the Division of Public Health and other databases (e.g., EMRs) to highlight and target behavioral health needs.

5. Enhance integration across public health areas.

6. Build on national models and local initiatives to expand integration in Nebraska communities.

Clear Impact Suite is an easy-to-use, web-based software platform that helps your staff collaborate with external stakeholders and community partners by utilizing the combination of data collection, performance reporting, and program planning.

Scorecard Container Measure Action Actual Value Target Value Tag S A m/d/yy m/d/yyyy