Integrated Care ACTion in Colorado
Nancy Valentine, RN, PhD, MPH, FAAN, FNAP

We all know that integrated care is an important and growing trend in healthcare. Our current system is fragmented and fraught with problems. The movement towards integrated care means embracing a patient-centered, seamless model that addresses the full spectrum of patient needs. Psychiatric nurses know the need for this better than most. The practicalities of implementing such a system, however, are complex. The Advancing Care Together (ACT) program is one project that is exploring the viable ways in which primary and mental health care can be blended together in a real world setting. APNA member Nancy Valentine, a member of ACT’s National Steering Committee, recently spoke with us about the project.

ACT is a collaboration between behavioral health, substance use, and primary care communities sponsored by the Colorado Health Foundation. It is a four year program that will fund 11 demonstration projects that will seek, through various approaches, to implement patient-centered medical care that integrates mental health, substance abuse, and primary care. The program is divided into three phases: (1) the call for proposals and funding of up to 12 grantees, (2) three years of work on the implementation and evaluation of the demonstration projects, and (3) a synthesis of lessons-learned and subsequent dissemination of best practices to key populations in Colorado and across the nation.

The program is in part meant to provide “adjunctive support to the goals and objectives of health care reform,” explains Dr. Valentine. One huge challenge facing the implementation of integrated care right now is money. “There is little funding for it,” she notes. Through the ACT grants, Colorado is seeking to provide some of the needed funding to communities across the state and in the process perhaps formulate some guidelines for the future. The success of the program will depend upon the vision, innovation, and practical knowledge of people who are in the trenches providing day-to-day care and who understand the limitations of local resources and the variability of patients’ needs.

When we spoke Dr. Valentine had just returned from a trip to Colorado, where review of the grant proposals had just begun. She describes it as both a “humbling” and “inspiring” experience. Twenty one applications were submitted by a diverse group of primary care practices and community mental health centers across Colorado. They represented a “very beginning grassroots effort” and covered “all different approaches and ways to blend” care.

Dr. Valentine takes a very realistic view of the project: “The economics of this are going to be very hard,” she says. “In primary care settings there are very limited resources. As these teams of people try to organize additional services it becomes a manpower issue both from the perspectives of having people trained to bridge the psycho-social and physical health issues for vulnerable populations as well as having the finance to hire such individuals.” As for the outcome of the project she predicts “solid pilots, very good lessons learned, and hopefully guidelines for developing models that can be adopted on a national scale” for the future. The review process just finished this month and recipients of funding were notified July 18th. The funded projects are set to begin September 1st. 
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Nancy Valentine, PhD, MPH, MSN RN, FAAN, FNAP is a past president of APNA and currently leads the nursing and patient care services of a Jefferson Health System group of community hospitals in Philadelphia, Main Line Health System, Bryn Mawr, PA. Her experience includes leading the nursing service of the largest private psychiatric hospital in the US, McLean Hospital where her clinical work in alcohol and drug abuse research, and seminal work in developing clinical intervention services for impaired nurses was the focus of her doctoral work in health care economics. She also served as the national CNO for the Department of Veterans Affairs.

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