The notion of Integrated Health in behavioral health care is rooted in the need to improve the health outcomes in the lives of people in recovery from mental and/or substance use disorders. Preventative measures are critical to addressing the rates of chronic illness and premature death experienced by this population as well as creating a culture of wellness inside the walls of behavioral health care settings. Addressing the Social Determinants of Health such as housing, employment, and education equally supports changing the health and wellness trajectory of this vulnerable population.
Whole Self Care promotes integrated care within Wellness Works, S:US’ behavioral health clinic in Brooklyn. S:US created this program through SAMHSA’s Primary and Behavioral Health Care Initiative (PBHCI). Since its inception in 2016, Whole Self Care brings person-centered wellness initiatives to individuals with behavioral health conditions and demonstrates that positive health outcomes are achievable for individuals with mental health and substance use conditions. It started as an enhancement to the Wellness Works clinic and has become the driving force of care beyond mental health. It grew from an “add on” to mental health services to a fully embedded, holistic part of the clinic. Discussions transformed from “if you are interested in learning more about healthy living go talk to the Whole Self Care team down the hall” to “let’s work together as a team to determine and achieve your health and wellness goals.” This effort began when the Whole Self Care staff started to participate in therapists’ clinical case conferencing and found ways to weave wellness in with mental health treatment and services.
Whole Self Care’s person-centered approach to health and wellness and to addressing the Social Determinants of Health improved consumer physical health indicators from Baseline to Reassessment. Within the two years of implementation, consumer health outcomes improved in the following areas:
- Metabolic syndrome risk: 19.5% of consumers improved their blood pressure, with 6.5% reaching blood pressure levels that are no longer considered at-risk of hypertension.
- Obesity: Nearly half (47%) improved Body Mass Index and waist circumference.
- Tobacco cessation: About half of consumers demonstrated lower Breath Carbon Monoxide levels, with approximately 15% reducing their Breath CO to below-risk levels. The percentage of S:US consumers who reported not using tobacco products increased by 16.7% from baseline to reassessment, which is 12.2 percentage points higher than the combined increase in percentage of all PBHCI grantees (4.5%).
- Diabetes risk: 70% improved blood glucose levels with 30% reaching HgbA1c levels that are no longer at-risk.
- Heart disease risk: 57% of consumers improved their HDL Cholesterol and triglycerides levels, with 7% no longer at-risk. Nearly 77% improved their LDL Cholesterol levels.
S:US consumers also improved in several National Outcome Measures and exceeded the average percent change compared to other PBHCI grantees in key measures of substance use and other indicators of stability and wellness. Consumers reported positive National Outcomes Measures from Baseline to Reassessment in the following areas: • Substance Use: The percentage of S:US consumers who reported engaging in inpatient substance use treatment (past 30 days) increased by 50% from baseline to reassessment, whereas the combined percentage of all grantees who reported inpatient treatment decreased by 61.1%.
- Employment and Education: The percentage of S:US consumers who reported attending school regularly increased by 33.3%, whereas the combined average of all grantees reporting school attendance decreased by 6%. The percentage of S:US consumers who reported being currently employed or retired increased by 30%, which is 13 percentage points higher than other grantees (17%).
- Housing stability: The percentage of S:US consumers who reported having a stable place to live increased by 16.4% from baseline to reassessment, 5.8 percentage points higher than the combined increase in percentage of all grantees (10.6%).
- Overall functioning: The percentage of S:US consumers who reported better functioning in everyday life increased by 39.5%, 15.4 percentage points higher than the combined increase in percentage of all grantees (24.1%).
Many of the individuals referred to Wellness Works are homeless, living in shelters, or formerly homeless. Many have also experienced incarceration, a substance use disorder, and various forms of trauma. With the addition of Whole Self Care, the clinic can address the issues of individuals with multiple chronic health conditions, both known and unknown, and disconnection from care due to their living situation or having histories of negative interactions with health care providers.
Whole Self Care’s success and uniqueness transformed beyond groups and care coordination. It brought wellness programming to the Wellness Works clinic with the use of evidence-based practices such as Whole Health Action Management (WHAM), Solutions for Wellness, and Learning About Healthy Living (LAHL) in addition to peer and consumer-led healthy cooking and walking groups. Each person referred to Wellness Works meets with an RN for a health assessment and staff engages everyone in wellness planning including defining their vision of health and wellness and creating a wellness plan if they choose. From the onset, Peer Wellness Coaches introduce individuals to wellness activities and learning different ways to be an active participant in their wellness journey. The Peer Wellness Coach and members of the Consumer Advisory Board (CAB) also select a health topic each month to focus on and work with the RNs to provide relevant information and hold special events to engage people in the topic.
As a result of these efforts, both consumers and staff members became health informed and work toward achieving positive health outcomes together. For example, the entire Wellness Works clinic participated in a weight loss initiative driven from consumers expressing the need for more encouragement around exercise. Consumers and staff formed teams and kept track of their daily steps with updates displayed each week on bulletin boards and in a shared web portal.
S:US is committed to making primary care accessible and approachable for all by ensuring that wellness initiatives match the person-centered, trauma-informed care approach of the agency’s behavioral health care services. This includes hiring individuals with lived experience and medical professionals experienced in behavioral health conditions and homelessness. As a result of these efforts, both consumers and staff members are health informed and work toward achieving positive health outcomes together.