Susan Butterworth, PhD, MS Associate Professor, Oregon Health & Science University

1. Incorporating Motivational Interviewing into Clinic Practice for Medicaid Population with Complex Conditions Susan Butterworth, PhD, MS Associate Professor, Oregon Health & Science University President, Q-Consult

2. King County Care Partners (KCCP) • Chronic care management with commitment to patient-centered approach • Collaboration between health care practitioners & community service providers • Goal is improving health outcomes for high risk, complex Medicaid cases • Population served have multiple chronic diseases, mental health issues &history of substance abuse

3. King County Care Partners (KCCP) • RNs serve as care manager • Partners: Aging & Disability Services, Senior Services, community healthcenters, & Harborview Clinic • Access to team of health care professionals with clinical, psychiatric, chemical dependency, social work and pharmacological expertise • Outcome measures: • patient activation • utilization costs • clinical indices

4. Intervention Overview • One-day training in patient activation & use of Patient Activation Measure (PAM) • Two-day MI training with staff and leadership • Identification of internal mentors

5. Intervention Overview • MITI coding and monthly coaching (skill-building) sessions with mentors • Follow-up half day MI and Mental Health workshop • Identification of lead facilitator & support for self-management of program

6. Special Considerations for Medicaid Population with Complex Conditions • Decreased rate of successful follow-up; i.e. every contact counts • Increased number of co- and multi-morbid conditions and behavioral health concerns • Lower education and socioeconomic levels associated with increased barriers to medical care, and lower healthcare knowledge, ability to navigate system, and confidence levels • Increased level of defensiveness and feelings that system has let them down

7. Special Considerations for Medicaid Population with Complex Conditions • Increased level of cultural differences • traditional health care system views patients who do not follow treatment plans as ‘non-compliant’. • In some cases, they are discharged from their primary care clinic because they are deemed too challenging to work with • Medicaid patients who have dual diagnosis have pressing social issues which take precedence over medical treatment

8. Case Study • 45 year old female with Russian origin; poor English language skills and literacy • Homeless; living in tool shed with no electricity, plumbing, and heat • Conditions: schizophrenia, PTSD, alcohol & tobacco addiction, Chronic Obstructive Pulmonary Disease (COPD), diabetes

9. Case Study • KCCP care manager goals: get into public housing, address addictions, address diabetes control, refer to mental health specialist for review of meds • Patient goal: find housing that accept dogs • Intervention: Care manager successful in identifying housing that accepts dogs as primary goal • Outcome (as of 9/30/10): Patient in public housing; has agreed to mental health review; increased self-efficacy and activation