A look at Sí Texas Project's Integrated Behavioral Health models: CHISPA, TRIP for Salud y Vida, and Sí Texas Hope

By Anne Connor, director of community grants

In 2014, Methodist Healthcare Ministries of South Texas, Inc. launched the Sí Texas Project: Social Innovation for a Healthy South Texas (Sí Texas Project) with support from an unprecedented federal investment of $10 million by the Social Innovation Fund, a program of the Corporation for National and Community Service. Through the Sí Texas Project, Methodist Healthcare Ministries is evaluating nine evidence-based models of Integrated Behavioral Health (IBH) care, with some innovative aspects targeted at 12 counties within Methodist Healthcare Ministries' service area.

This week I'd like to take a closer look at three IBH models as part of the Sí Texas Project:

1. Community Healthcare InveSted in keeping Patients Active (CHISPA): El Milagro Clinic is implementing the Community Healthcare InveSted in keeping Patients Active (CHISPA) model in McAllen, Texas. This model is heavy on community-based chronic disease services, including the use of promotores in both the community and the clinic. The model utilizes monthly group-mediated cognitive behavioral meetings, and community-based services through the Healthy Living Partnerships to Prevent Diabetes (HELP PD). CHISPA will adapt the HELP PD model to account for the unique cultural and geographic needs of the Rio Grande Valley. An integral and innovative component of the CHISPA program, is the use of promotores, or community health workers. This community health worker-led health promotion intervention emphasizes integration and coordination of primary care with behavioral health care services, with community health workers integrated into the clinic team through depression screening and other patient services. A key component is the use of an occupational therapist to work with patients to identify needs early on, set goals and monitor progress. The intervention will include an initial meeting with an occupational therapist and follow-up as needed to coordinate and manage community-based services that meet the individual needs of patients, including referral to behavioral health services. The occupational therapist and the community health workers will also lead the group-mediated cognitive behavioral meetings.

2. Transportation for Rural Integrated health Partnership (TRIP) for Salud y Vida: The Rural Economic Assistance League, Inc. (REAL) is implementing the Transportation for Rural Integrated health Partnership (TRIP) model for Salud y Vida model, based in Alice, Texas, and covering a rural five-county service area. Like the Tropical Texas Behavioral Health model profiled in the previous blog, it focuses on the needs of Severe & Persistent Mental Illness (SPMI) consumers. This model was developed by REAL, in partnership with Coastal Plains Community Center, a local mental health authority serving SPMI patients; Kleberg County Human Services – Paisano Transit; and the South Coastal Area Health Education Center. The model responds to a specific need to expand the reach of current IBH services within the rural community, specifically to address the 22 percent (more than 1 in 5) consumer no-show rate for follow-up care. If patients aren't showing up for their follow-up appointments, there is little hope of advancing their health care outcomes. The key element of the TRIP for Salud y Vida model is the systematic and seamless offering of transportation services and programs to build self-empowerment to SPMI patients in the five-county service area. All TRIP for Salud y Vida consumers have a behavioral health diagnosis including severe depression, bipolar or schizophrenia.

3. Sí Texas Hope: Hope Family Health Center is implementing this collaborative care model at its clinic in McAllen, Texas. Hope Family Health Center has already begun integration of services, and the Sí Texas Project will enable them to move further along the integration continuum. The intervention involves moving from Hope Family Health Center's current model, where medical and behavioral providers work with each other episodically, to a more fully integrated model with care coordination, shared treatment plans, shared service provision, and shared record keeping. To achieve this enhanced level of integration, Hope Family Health Center will change its current primary care workflow to include a behavioral health specialist who will conduct assessments, provide initial counseling (individual or group), and coordinate referrals to care management and/or community-based health services. They will also include a care coordinator to manage referrals and follow-up and a transitional nurse to provide health and nutrition coaching and medication management. The new model of care will emphasize more collaboration between primary care and behavioral health care providers, including enhanced communication.

A series of blog articles will be added to the Methodist Healthcare Ministries Blog over the next few weeks to introduce additional models. To stay in the loop, please subscribe to the Blog at www.mhm.org/blog.