Supporting Behavioral Health Home Approaches for Improving Patients’ Health and Wellness

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project made a behavioral health home program part of regular care for youth with mental health conditions and adults with substance use disorder.

Many people who have mental health conditions or substance use disorders are at high risk for long-term health problems like diabetes and heart disease. Making healthy behavior changes may prevent these health problems. Behavioral health homes are a healthcare service delivery model to improve patients' overall health and wellness. They help patients to address physical health conditions and provide or coordinate primary care services within a behavioral healthcare setting.

What was the goal of this implementation project?

In a completed PCORI-funded study, researchers found that two behavioral health home approaches improved the health and wellness of people with serious mental illness. The two approaches were access to a wellness nurse versus worksheets and manuals to help patients improve their physical health.

Both approaches brought a focus on physical health into behavioral healthcare services. They helped people to get routine preventive care and address physical health challenges, and to identify and work toward health and wellness goals. After the study, the project team combined the two approaches into one program called Behavioral Health Home Plus, or BHHP.

This implementation project expanded BHHP to youth with mental health issues and adults with substance use disorders.

What did this project do?

The project team put the BHHP program in place at 12 sites in Pennsylvania: The sites included:

• Five psychiatric residential treatment facilities, or PRTFs, for youth. PRTFs provide care for youth with mental health issues. These youth require more support than outpatient or other community-based care can provide.
• Seven opioid treatment programs, or OTPs, for adults. OTPs combine medicines and outpatient counseling to treat opioid use disorder.

At each site, the project team worked with staff to:

• Identify a team to promote use of BHHP and monitor the quality of the BHHP approach. Each team had three to five staff, which could include administrators; clinicians such as doctors, social workers, counselors, or nurses; and residential staff. The team also included one person who was receiving services or a caregiver.
• Train 23 staff champions to serve as wellness coaches. These coaches learned how to engage people in their physical health using the 8 Dimensions of Wellness model¹. They learned how to complete health assessments, work with people to set goals, and help them manage their health problems and make positive lifestyle changes.
• Make wellness coaching part of regular care at the sites.
• Establish a culture of wellness.

The project team provided sites with a manual on the program, training for staff, and self-care resources. The team also gave sites ongoing feedback and support. For 12 months, the team held monthly meetings with two learning collaboratives to support the use of the BHHP program—one for PRTFs and one for OTPs.

Using a train-the-trainer approach, staff champions at each site trained other staff. At PRTFs, 171 staff received training. Staff included behavioral nurses, therapists, dietary workers, and residential staff. At OTPs, 108 staff received training. These staff included nurses, counselors, and case managers.

What was the impact of this project?

During the project, PRTFs provided care to 541 youth and OTPs provided care to 4,313 adults.

The project team’s evaluation showed that:

• People in BHHP reported high confidence in managing their health and wellness. At PRTFs, youth reporting high confidence increased from 0% before the program to 8% at 12 months and 43% at 18 months. At OTPs, ratings increased from 0% to 65% at 12 months and 67% at 18 months.
• People in BHHP were more involved in managing their health. At PRTFs, youth reporting high involvement increased from 0% before the program to 50% at 12 months and 62% at 18 months. At OTPs, adults’ involvement increased from 7% to 67% at 12 months and 69% at 18 months.

Providers monitored 139 youth at PRTFs and 668 adults at OTPs during the learning collaborative. The project team found that:

• Nearly all people had documented their wellness goals. At PRTFs, youth with documented wellness goals increased from 20% at the start of the program to 90% at 12 months and 100% at 18 months. At OTPs, people with wellness goals increased from 14% at the start of the program to 92% at 12 months and 94% at 18 months.
• Nearly all people had completed physical health assessments. At PRTFs, youth with completed assessments increased from 80% at baseline to 100% at 12 and 18 months. At OTPs, adults with completed assessments increased from 0% to 99% at 12 and 18 months.

Physical health service information was available for 354 youth in PRTFs and 689 adults in OTPs. The project team found that:

• At 12 months, coordination between physical and behavioral health providers occurred for 90% of youth at PRTFs and 63% of adults at OTPs.
• Overall, unplanned use of health care, such as visits to the emergency room, decreased at both PRTFs (p<0.0001) and OTPs (p<0.0002). Use of outpatient specialty care also decreased in both settings (p<0.0001). The number of hospital stays didn’t change.
• Use of primary care services didn’t change at PRTFs but it decreased at OTPs (p<0.0001).

More about this implementation project:

1. https://mfpcc.samhsa.gov/ENewsArticles/Article12b_2017.aspx