Building Bridges Conference
15 minute welcoming remarks
1 p.m. Tuesday June 15, 2010
Austin, TX
1. Introduction
Good afternoon
Welcome to the Building Bridges Conference
Our agency vision is a healthy Texas.
Our mission at DSHS is to improve health and well being in Texas
To accomplish that mission we rely on partnerships
We rely on models and programs that effectively integrate care
We rely on effective program collaboration
We rely on building bridges that promote a healthier Texas
2. Behavioral Health & Clinical Care
DSHS began operating in 2004
We were created in part to integrate agencies focused on public health with agencies
focused on behavioral health
Integrated behavioral health care with clinical care is based on a growing body of
scientific research
Integration creates opportunities to address systemic dysfunction that comes with
fragmented care
In a review of multiple studies, roughly 1/3 of individuals with serious mental illness
(SMI) had at least 1 undiagnosed medical disorder
People with SMIs are often linked to poor diet, obesity, high smoking rates, & use of
alcohol & drugs
Also, some drugs used to treat SMI’s are linked to weight gain, onset of diabetes,
Adults with SMIs have higher rates of chronic medical conditions, including
hypertension, HIV/AIDS & diabetes, more multiple medical conditions, & higher
premature mortality
Despite a higher incidence of chronic medical disorders, adults with severe mental
illness have worse access to care & the care they receive is lower quality care
For example, individuals with schizophrenia have a 20% shorter life expectancy that the
overall population
Experts recommend MH providers work with primary care providers to perform physical
health monitoring and behavioral health monitoring in primary care and other settings
This approach is necessary to address comorbidities.
3. DSHS & Integrated Care:
Our agency is involved in multiple initiatives whose purpose is to ensure that each
person receives the comprehensive care they need
These include:
Mental Health Transformation (improved MH services across state agencies)
Adolescent Mental Health Screening (screenings, referrals, treatment)
Project Insight (SA screening in primary care settings)
Youth Suicide Prevention Project (screening, referrals, interventions in 3 TX counties)
Clinical Management for Behavioral Health Services (CMBHS) (information-sharing
tools)
Integrated disaster response (to ensure mental health services at disaster/shelter sites)
Tobacco (combines PH model w substance abuse services for prevention/cessation)
4. DSHS efforts to link internal programs/initiatives re disease prevention/health
promotion
Initiatives to integrate care and implement program collaboration extend across multiple
DSHS programs & divisions
Some examples:
Obesity
Pooled funding from three different funding sources
1. New appropriations in last legislative sessions for obesity
2. funds from Title V– maternal child health block health program
3. funds from Border Health
Rationale: In these three programs Obesity is a priority.
Instead of each program going out with separate RFP’s they combined funds and
created one RFP to have a greater impact and consistency across the agency in what
we are asking communities to do.
This also helped LHD’s by requiring that they apply for one RFP instead of multiple.
Breast Feeding
Collaborative strategic planning for breast feeding promotion because breast feeding is
a shared priority
It is essential to include all relevant programs in the planning process.
However, WIC is taking lead in strategic planning.
Looking at ways to collaborate not only in planning, but in funding DSHS staff and
resources to support community initiatives.
Effort will include Title V, as well as breast feeding strategies that prevention and
preparedness is using for obesity prevention.
School health program
P&P handles contracts with the education service centers – (regional folks who support
the schools)
We pool funds from mental health and substance abuse, maternal and child health,
diabetes, abstinence
3 different divisions and multiple programs are involved in these contracts
Goal: to coordinate our priorities for training and technical assistance going out to
school districts.
We consider this a coordinated and comprehensive approach to working with schools
on health issues
Diabetes Council and Cardiovascular Council
Pooled funding to go into a community health center project to improve standards of
care- P&P monies
Targeting community health centers
Looking at the system as a whole to ultimately create improved systems of care for
community health center.
This will not only benefit those suffering from heart disease & diabetes but all
conditions.
5. Unhealthy behaviors drive chronic disease rates
The leading causes of death in Texas are heart disease, cancer and stroke.
However, the CDC describes the 3 leading “actual” causes of death to be:
1. poor diet/lack of exercise. 2. tobacco use 3. immoderate use of alcohol
Whatever chronic disease we might consider: heart disease & stroke, diabetes, many
cancers—unhealthy behaviors drive chronic disease rates and account for 2/3 of all
deaths in Texas.
Any effective intervention in any Texas community that lowers smoking rates or
significantly increases physical activity & healthy eating should, over time, lower chronic
disease rate across the board.
6. Improving public health through program collaboration
Texas already benefits from chronic disease program integration with outside partners
We strive to efficiently use our staffs, our funds, our surveillance and our intervention
efforts.
Partnerships help us overcome constraints in funding and resources.
However we recognize barriers and challenges as we work across programs, agencies
and organizations to provide better care.
Those barriers include: competition for funding, categorical funding, concerns about
program or organizational identity, constituents, and program outcomes or
achievements
This conference will provide opportunities for us to learn how to overcome some of
these barriers.
Let me offer the following broad guidelines
Program integration should help participants know what actions are being taken & why.
Integration is a process that seeks consensus
Consensus must be reached on both short and long-term goals.
It is essential for partners to:
respect each program’s identity
preserve individual program expertise
Sustain constituencies
Maintain accountability to categorical program priorities
Celebrate and replicate successful interventions while at the same time
Encourage cooperation, coordination and collaboration
Improved population health is the most important guiding principle for program
integration
How we work together to improve the health of common populations is our biggest
challenge
Clearly we must:
Improve our programs’ ability to address diversity
Reduce health disparities
Be measurable
Use evidence-based practices
The shift in focus from risk factors and diseases to population-based chronic disease
prevention is a difficult shift to navigate.
It is difficult in part because we must maintain a focus on risk factors, disease treatment
and disease research
It is difficult because we must maximize the impact of investments across categorical
programs
It is difficult because we are developing and evaluating new models for chronic disease
prevention
We know our collaborative efforts must be community-based
These efforts must focus more and more on the built environment
William Roper, a former CDC director, described public health as “the intersection of
science and politics’
We must effectively represent the scientific side of the conversation
In a somewhat new and expanded role for public health, we must advocate “health in all
policies and settings.”
Policies in agriculture, education and transportation affect incidence rates of chronic
diseases
The availability and quality of parks and recreational facilities affects the impact of
chronic diseases in our community
As does the availability and affordability of fresh fruits and vegetables
All this means that there are many emerging opportunities for us to work together, learn
from each other, explore new approaches, and ultimately, create a healthier Texas
through effective collaboration.
Thank you for coming
Enjoy the conference.