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CCUIH's Six Levels of Integration Survey
CCUIH has culturally adapted the SAMHSA's Six Level of Integration Tool to include the specific needs of AI/AN community.
This survey assesses your clinic's level of collaboration/integration based on this adapted model. If you have any questions about the survey please contact April at
april@ccuih.org
.
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* Indicates required question
Which CCUIH member organization do you represent?
*
Your answer
What is your job title?
*
Your answer
Does your Primary Care (PC), Behavioral Health (BH), and Traditional Healing (TH) take place at the same site?
*
Your answer
Clinical Delviery
Screening and assessment :
*
Done according to separate PC/BH practice models
Based on separate PC/BH practices; information may be shared through formal requests
PC and BH agree on some specific screenings or other criteria for more effective in-house referral
PC and BH agree on some specific screenings, based on ability to respond to results
PC and BH have a consistent set of agreed upon screenings across disciplines, which guide treatment interventions
All practitioners us standard practice of using population-based PC and BH screenings, with results available to all and response protocols in place
Other:
Treatment Plans:
*
Separate treatment plans for BH and PC
Separate treatment plans shared based on established relationships between specific providers
Separate treatment plans with some shared information that informs them
Collaborative treatment planning for specific patients
Collaborative treatment planning for all shared patients
One collabrative treatment plan for each patient
Other:
Panel Management:
Treatment plans managed by individual providers
Some joint management in specific issues
Providers form a care managemnt team for complex care management for high risk/multiple diagnosis patients only
Most patients recieve integrated panel management
All patients receive integrated panel management
Other:
Clear selection
Evidence-Based Practices (EBP):
*
EBPs for PC and BH are implemented separately
Separate responsibility for care/EBPs
Some shared knowledge of each other’s EBPs, especially for high utilizers
Some EBPs and training shared, focused on interest or specific population needs
EBPs shared and respected across system with some joint monitoring of health conditions for some patients
EBPs are team selected, trained and implemented across disciplines as standard practice
Other:
Community Defined Practices (CDP):
*
CDPs are not considered valid by PC and BH providers
Some understanding of CDPs
Use of CDPs , with some shared knowledge, especially for high utilizers
Some CDPs and training shared, focused on interest or specific population needs
CDPs shared and respected across system with some joint monitoring of health conditions for some patients
CDPs are team selected, trained and implemented across disciplines as standard practice
Other:
Patient Experience
Patient Health Needs:
*
Physical and behavioral health needs treated as separate issues
Health needs are treated separately, but records are shared, promoting better provider knowledge
Health needs are treated separately at the same location
Patient needs are treated separately at the same site, collaboration might include warm hand-offs to other treatment providers
Patient needs are treated as a team for shared patients (for those who screen positive on screening measures) and separately for others
All patient health needs are treated for all patients by the team, who function effectively together
Other:
Patient referrals:
*
Patient must negotiate referrals with varying degrees of success
Patients may be referred, but variety of barriers may prevent access
Co-location improves success of referrals, although who gets referred may vary by provider
Internally referred with follow-up, with occassional collaboration
One-stop shop; care is responsive to patient needs by a team of providers
Unified practice; patients experience a seamless response to all healthcare needs
Other:
Practice/Organization
Integration Leadership:
*
No coordination or management of collaborative efforts
Some practice leadership in increasing systematic information sharing
Organization leaders supportive of integration, systematic information sharing
Organization leaders support integration through mutual problem-solving of some system barriers
Organization leaders support integration, efforts placed in solving as many system issues as possible, without changing fundamentally how disciplines are practiced
Organizational leaders strongly support integration as practice model with expected change in service delivery, and resources provided for development
Other:
Provider buy-in
*
Little provider buy-in to integration or even collaboration
Some provider buy-in to collaboration and value placed on having needed information
Provider buy-in to making referrals work and appreciation of onsite availability
More buy-in to concept of integration but not consistent across providers, not all providers using opportunities for integration or components
Nearly all providers engaged in integrated model. Buy-in may not include change in practice strategy for individual providers
Integrated care and all components embraced by all providers and active involvement in practice change
Other:
Coordination of care:
No care coordination
Care coordination is solely dependent on panel management (No designated care coordinator, case manager, etc.)
Designated care coordinator or case manager for high-risk patients
At least one full-time dedicated staff focused solely on care coordination for each patient
Other:
Clear selection
Tacking Referrals
Provider notes/Use of EHR
Designated care coordinator tracks access, service, follow up
Other:
Clear selection
Business Model
How separate is your funding for PC and BH?
Completely separate.
Separate funding, but may share grants
Blending funding based on contracts, grants or agreements
Integrated funding, based on multiple sources of revenue
Other:
Clear selection
Do PC and BH share resources?
May share facility expenses
May share office expenses, staffing costs, or infrastructure
Variety of ways to structure the sharing of all expenses
Resources shared and allocated across whole practice
Other:
Clear selection
Are your billing practices separate for PC and BH?
Yes
No, billing maximized for integrated model and single billing structure
Other:
Clear selection
Traditional Healing
Rate your organization's support for collaboration with traditional healers:
No organizational support for collaboration with Traditional Healers
1
2
3
4
5
6
Organizational support for the implementation and success of a completely integrated model, where Traditional Healing is treated with the same value as Primary Care and Behavioral Health practices
Clear selection
Rate your practitioner's support for collaboration:
Primary and Behavioral Health Practitioners have limited experience with alternative/cultural forms of healing
1
2
3
4
5
6
All practitioners have been exposed to, understand and respect the value of traditional healing
Clear selection
How do community members access traditional healers?
Community Members must access Traditional Healers entirely outside of the clinic.
Access to Traditional Healing to limited to community events sponsored by the clinic.
Community Members can access Traditional Healers through the clinic.
Community Members can access Traditional Healers through staff member dedicated to providing access
Other:
Clear selection
What is communication with Traditional Healers driven by?
Communication and use of Traditional Healing is driven by client request and/or community or staff recommendation
Communication driven by patient, staff and some practitioners in-the-know
Communication driven by patient, key staff (care coordinators), and some practitioners
Communication is driven by a cultural shift within the institution that believes in holistic wellness; all involved recognize the value of Mind, Body, Spirit, Community
Other:
Clear selection
Are there operational systems in place for Traditional Healers?
No
Yes, operational systems exist but are solely grant-driven
Yes, Traditional Healers are built in operational structure
Other:
Clear selection
Do Traditional Healers have access to EHR?
No.
Yes, low-level limited access.
Yes, full access.
Other:
Clear selection
Are there systems in place to help Traditional Healers become HIPAA compliant?
Yes
No
Other:
Clear selection
Do practitioners understand community codes of privacy relating to traditional healing?
Yes
No
Other:
Clear selection
Do Traditional Healers participate in care planning?
No.
Yes, they are included in care planning per patient request.
Yes, Traditional Healers are included in care plan meeting and practitioners are willing to treat Traditional Healers as part of the care team.
Other:
Clear selection
Is there designated space for Traditional Healers at the clinic?
No.
Yes, but space is not consistently available.
Yes, space is allotted for Traditional Healing and Healers.
Other:
Clear selection
Are Traditional Healers solely responsible for supplying all components of their practices?
Yes.
No, when appropriate clinic will provide supplies.
Other:
Clear selection
Do Traditional Healers have access to outdoor space?
No
Outdoor space is limited, but possible.
Outdoor space has been identified and is readily available for Traditional Practices
Other:
Clear selection
Traditional Health Sustainability
How is Traditional Healing at your clinic funded?
No funding for Traditional Healing.
Specific funding for Traditional Healing.
Blended funding, based on contracts, grants, or agreements.
Integrated funding, based on multiple sources of revenue
Other:
Clear selection
Do Traditional Healers have access to resources that PC and BH have?
No sharing of resources
May share office expenses, but no support for outside space costs or supplies
Traditional Healing is always considered in development plans
Resources shared and allocated across whole practice
Other:
Clear selection
Are there billing practices for Traditional Healing?
No billing practices
Billing function for Traditional Healing being tested through innovative funding options
Billing maximized for integrated model and single billing structure
Other:
Clear selection
How are Traditional Healers usually compensated?
Traditional Protocol is followed for payment i.e. tobacco, wood, food, cultural gifts.
Often times no payment is provided because the institution views this as a community service
May receive payment for providing a one-time service through grant funding (relate to a specific project) or other institutional means, but payment never includes cost of medicines, travel, preparation, etc.
Other:
Clear selection
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