Welcome to the Behavioral Health Integration Initiative (BH2I) Cohort 1

The 12 grantees are a mix of IHS service unit, Tribal, and Urban locations: 1 IHS, 7 Tribal, and 4 Urban health facilities. Through this page you will be able to access each grantee’s project summary via links. All information provided is current as of December 30, 2021.

During the third year of their grant, the BH2I grantees were met with an immense challenge near the beginning of 2020: the COVID-19 pandemic. The grantees are in a unique position to examine how their integrated models of care can be adapted to meet their communities needs in response to the pandemic. Additionally, the data they collect can be demarcated into pre-pandemic (before February 29, 2020) and during pandemic (after March 1, 2020). Furthermore, as the pandemic continues, the grantees are finding that their pivoting strategies to support their communities may change into something more permanent rather than temporary techniques.

IHS granted the grantees a fourth year to their grants to help them through this pandemic challenge: October 2020 through September 30, 2021.

The summaries under each grantee link describe the grantee’s community, project scope, goal and objectives that were included in the original grant application. In addition, the BH2I T/TA staff members provide their perspectives of how the grantee is progressing towards and their challenges in the following areas.

  • Accomplishment of grant goal and objectives,
  • Assessment between initial grantee self-assessment and T/TA staff appraisal using the SAMHSA-HRSA Center for Integrated Health Solutions’ six levels of integration scale of the grantee as requested in the grant application, and

Additionally, the summaries include COVID-19 responses within the project updates and are not separated out.

The BH2I T/TA Center staff members have been collecting best practices and lessons learned from each grantee. The grantees have also generously shared their standards of care they developed during the last three years. In the past several months since the pandemic began and as it continues, we hear from the grantees that if it wasn’t for the implementation of their integrated care models and the support provided by everyone associated with the BH2I T/TA Center, they wouldn’t have been able to respond to the needs of their communities as quickly during this crisis.

COVID-19 Pandemic

Each BH2I grantee responded to the pandemic and found that most of them were better equipped to respond because of their integrated care projects. During this quarter (October 1, 2020 – December 30, 2020), the majority of the grantees are finding themselves developing workflows that include variations of tele-health, new processes to ensure that everyone receives care, and in some cases, the tools and equipment to facilitate a visual virtual call.

Many of the grantees noted that their patients prefer the telephone rather than a virtual face-to-face call, which in most cases was due to remote locations, lack of or poor internet service, or no private access to a computer or computer-like device. One grantee did notice during a virtual call that the patient has definite social determinants that were affecting the health of the entire household (e.g., bugs, rodents), and that the grantee could provide all the treatment possible, but what was really needed was pest control to alleviate the issues that were adding to the behavioral health issues.

BH2I Grantee Best Practices Observed

Common Barriers among Sites

Up until December 2020, the BH2I T/TA Center team identified common barriers seen across most of the 12 grantee sites.

  1. Tribal and clinical leadership not understanding the effectiveness of integrated care and the impact upon the community at large. This lack of understanding leads to inefficiencies in supporting the project, and the BH2I team as they work to complete the goals, objectives, and track the outcomes of the project.
  2. Tribal and clinical fiscal managers not understanding the need for timely responses for monetary requests relevant to implementing the project activities. For example, at least two grantees have fiscal managers that will not release funds for BH2I teams to attend trainings that are paramount for their projects. Individuals are left to pay for the trainings out of their own pockets and are not reimbursed by the BH2I project’s fiscal administrators.
  3. Indian Health Service internal processes for BH2I project staff turnover. For example, a few grantees have submitted changes for authorizing officials that have not received a timely response for submitting carry-over requests.
  4. Primary care providers resisting change and implementing an integrated care model.
  5. Loss of key personnel during the grant implementation or staff not hired or found to replace personnel.

However, because of the pandemic, the five common barriers are still in place, but are overshadowed by the challenges seen during the pandemic.

  1. Staff and family infected by coronavirus.
  2. Deaths in the community.
  3. Patient isolation increasing substance use, anxiety, violence, and suicidal ideation.
  4. Disruption of integrated care model (e.g., lack of warm-handoffs and referrals).

Potential Solutions to Common Barriers

  1. Tribal and clinical leadership required to attend a webinar on the effectiveness of integrated care, impacts on communities where implemented, as well as the expected roles and responsibilities of tribal and clinical leadership in regard to BH2I projects. Additionally, the project staff should attend board meetings, tribal council meetings, to provide updates and status of the project regularly. All staff members should be able to explain the project to everyone who asks.
  2. Indian Health Service through the office of grants management provides a required training on BH2I fiscal training for grantees and grantee administrators on federal expectations of fiscal management as well as the expected roles and responsibilities of tribal and clinical fiscal managers in regard to BH2I projects’ meeting their goals and objectives through activities identified in the grant application
  3. Indian Health Service provides a required webinar for all grantees, tribal and clinical administrators on grant management process in regard to change of authorizing officials, project directors, report submissions, and budget modifications.
  4. Drs. Raney and Edwards provide a required training for Primary Care staff (doctors, nurses, allied health professionals) on integrated care approach. At least 5 trainings at 1 hour each.
  5. Grantees develop a project book and process to onboard new people immediately to get them up to speed. The project book details the specifics of the grant, goals objectives, activities to complete the objectives, and the expect outcomes with the metrics tracked for the outcomes. Additionally, a detailed description of the project, why the project is important, roles of people on the project, update with accomplishments, barriers, potential solutions, actual solutions, current outcomes with metrics and transition plans for project staff and leadership. It is a current book of what’s going on with project. Update weekly.
  6. BH2I project staff and family members need to be supported during their quarantine and/or convalescence. Support can be phone or virtual calls to discuss anxiety and brainstorm solutions that will fit the BH2I project staff needs.
  7. BH2I project staff need to be support during the deaths in the community. Support can be phone or virtual calls to discuss grief and brainstorm solutions to minimize contact during COVID-19 pandemic that will lead to reduction in community deaths.
  8. BH2I project staff need support to help community to alleviate use of substance, decrease anxiety and suicide ideation. Support can be phone or virtual calls to discuss the increase levels in destructive behaviors and brainstorm solutions that will fit the BH2I project staff needs.
  9. BH2I T/TA Center will collaborate with each grantee to identify the adaptations occurring and what is working with their communities to provide integrated care services.

The BH2I Cohort 1 list of grantees are as follows