SCHARP Care: Primary and Behavioral Healthcare Integration

The new SCHARP program specifically targets adults with serious mental illness (SMI) who trust their mental health provider and are more likely to regularly visit a physician there.  “Our clients trust our therapists and expert behavioral health team, but they typically see a physician only through the emergency room,” said Dr. Barbour.  “Not only is that terribly expensive, but it’s also episodic care rather than continuous care with a health professional who can effectively treat chronic conditions over time.  Our clients with SMI also don’t usually survive well in large, busy, or crowded waiting rooms which can be scary and intimidating. By integrating primary medical care into our existing programs, we can leverage that trust to help them maintain overall health in a holistic way, supporting recovery and wellbeing essential to overcoming homelessness.”

Launching Winter of 2015, SCHARP’s integrated physical and mental health program seeks to improve outcomes for adults with serious mental illness (SMI).  High quality, accessible medical care will benefit our community’s most vulnerable individuals who are:
· Homeless
· Veterans
· Recently incarcerated
· Trauma affected
· Diagnosed with co-occurring substance use disorders
· Living with HIV/AIDS    

Project Scope:
· Serving South Los Angeles and L.A. County Service Planning Area 6
· Integrated, person-centered system of care focused on improved health outcomes, cost effectiveness, and patient experience (quality and satisfaction)    

· Data-driven, quality improvement approach to population health management
· Implemented by expert, credentialed professionals and peers, with collaborating community partners
· Incorporates National Standards for Culturally and Linguistically Appropriate Services in healthcare    

Strategy and Interventions:
Trauma informed, integrated primary care and behavioral healthcare. 

A Health Home Model offering Evidence Based Practices and other promising practices demonstrated effective with our focus population.  

· SBIRT: Screening, Brief Intervention, Referral, and Treatment
· Million Hearts: Evidence-based treatment protocols for improving blood pressure
· HARP: Health and Recovery Peer Program for chronic disease self-management
· Peer-to-Peer Tobacco Dependence Recovery Program for cessation
· NEW-R: Nutrition and Exercise for Wellness and Recovery for weight management & wellness    

Goals & Objectives:
Develop an integrated, person-centered system of care that achieves the healthcare triple aim of improved outcomes for up to 400 beneficiaries, cost effective services and high quality and patient satisfaction.  

· Improved physical and mental health as measured by PROMIS Global Health and Physical Health Indicator
· Reduced substance use as measured by NOMS, IMR and PROMIS-Derived Substance Use Scale
· Review aggregate outcome data quarterly to determine gaps or disparities in service and to maintain continuous program improvement
· Determine predictors of positive client outcomes      

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