Evaluation
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2011 CHAMMP Report:
Disability Lifeline (DL) and Uninsured Mental Health Integration Program: Implementation Status Report
HIGHLIGHTS for the period JULY 1, 2008 to June 30, 2011
High-Risk Pregnant & Parenting Women: Implementation Status Report
HIGHLIGHTS for the period July 1, 2008 to December 31, 2010
Presentation on February 17, 2011:
By Jürgen Unützer, MD, MPH, MA to the Disability Lifeline Working Session in the Washington State House Appropriations Committee
Overview
The Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP—www.chammp.org) at the University of Washington is responsible for evaluation of the Mental Health Integration Program (MHIP). MHIP is comprised of two components: the Disability Lifeline Pilot funded by the Mental Health Transformation Grant and the Washington State legislature and the Integrated Behavioral Health Pilots funded by the King County Veterans Levy, King County Human Services Levy, and the Children’s Health Initiative. The MHIP evaluation activities to date consist of tracking the progress of program implementation in participating primary care and mental health clinics and producing periodic reports documenting that progress for key stakeholders.
Populations
MHIP implementation is being tracked for the following populations:
- Disabilty Lifeline segment of the Medicaid population
- High Risk Pregnant and Parenting Women
- Low Income Children
- Veterans
- Uninsured (under development)
- Older Adults (under development)
Two of these populations are featured below: Disability Lifeline clients and High Risk Pregnant and Parenting Women.
Disability Lifeline. The Disability Lifeline program provides cash and medical benefits for low-income adults without dependents who are physically or mentally incapacitated and expected to be unemployed for at least 90 days. In January, 2008, the state legislature made funding available to add mental health services to existing managed care medical services in King and Pierce Counties for Disability Lifeline clients. Because many Disability Lifeline clients have mental illness and/or substance abuse problems, providing these mental health services (including referral to chemical dependency treatment) has the potential to improve health outcomes and significantly reduce emergency room, specialty care, and prescription drug costs. The MHIP program for Disability Lifeline clients will be expanded statewide beginning in October, 2009.
As of the end of November 2009, 4,298 Disability Lifeline clients were enrolled in the program. The average age of these clients is 42 years, 55% are male and about 34% are homeless. Most (78%) have been diagnosed with depression and a substantial proportion has been diagnosed with anxiety (51%), substance abuse (23%), bipolar disorder (20%), and/or post-traumatic stress disorder (17%). As of the end of November 2009, 1,088 clients have been referred to Disability Lifeline-Expedited (DL-X) funding. Overall, 38% have shown clinical improvement in their depression symptoms as measured by a 5-point or more change in the PHQ-9 screening instrument; among clients with severe depression and at least two scores, 49% showed improvement. 27% of clients with at least two anxiety scores showed significant improvement in anxiety symptoms; among clients with severe anxiety and at least two scores, 36% showed improvement.
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High-risk pregnant and parenting women. The MHIP for high-risk mothers aims to identify and treat maternal depression and other mental health disorders in low-income pregnant woman and mothers who live in King County. The program is funded by the King County Human Services Levy.
As of the end of November 2009, 628 mothers were enrolled in the program. They ranged in age from 15 to 67, with an average age of 31 years. Approximately 27% were pregnant at the time of enrollment. The majority were Hispanic (26%) with 14% Caucasian, 10% Asian, and 8% Black/African American. Forty-one percent (41%) were identified as being best served in a language other than English. Almost all (91%) had a diagnosis of depression, with 32% diagnosed with anxiety. Overall, 64% have shown clinical improvement in their depression symptoms as measured by a 5-point or more change in the PHQ-9 screening instrument; 44% have shown clinical improvement in their anxiety symptoms as measured by a 5-point or more change in the GAD-7 screening instrument. Those with most severe depression at baseline and those with most severe anxiety at baseline showed the greatest improvement.
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