Transparencies December 2021

Celebrating Progress and Innovation in 2021

A Message From Our CEO

Despite the challenges our community faced this year, Integral Care remained focused on supporting the health and well-being of our community and those we serve. As 2021 comes to an end, I would like to celebrate the incredible work of our dedicated staff and look back at some of the ways Integral Care created value, innovated, and collaborated to address the needs of all communities in Travis County. These areas of focus are goals set forth in our Strategic Plan and guide our work every day.

Innovating – Embracing Effective Models of Care to Ensure Equity, Access, Value and Quality

With a commitment to race equity, our teams used data to reduce racial disparity within diagnostic categories for African American males and children and youth of color
Expanded onsite mental health response to 24/7 coverage at the 911 Call Center, with 5,048 calls transferred to Integral Care clinicians and over 80% of those calls diverted from police response
Moved 12 individuals with intellectual and developmental disabilities from jail into more appropriate settings as part of the IDD-Mental Health Criminal Justice Collaborative with the District Attorney’s Office
Provided mental health and disaster response expertise throughout COVID-19 pandemic and Winter Storm Uri by staffing isolation facilities and ProLodges, helping move people experiencing homelessness to lifesaving shelter, and ensuring behavioral health supports were available to people in need; supporting the work of the City of Austin and Travis County

Creating Value – Ensuring Operational Excellence, Sustainability, Value and Equity

Photo of Terrace at Oak Springs building

Completed Racial Equity Plan and hired a racial equity consultant, with a commitment to eradicate our own institutional racism and structural inequities
Completed a return-on-investment study for Terrace at Oak Springs, our 50-unit Housing First apartment community for people who formerly experienced homelessness, showing community savings of $725,000 in one year
Trained Dell Medical School students, psychiatry residents and fellows as well as University of Texas social work, psychology and nursing graduate and doctoral students to expand knowledge of community-based mental health care and substance use treatment and build local workforce
Provided free COVID-19 testing and COVID-19 vaccines for staff and clients to support health and safety of our community

Communicating, Collaborating and Connecting – Enhancing Public Trust and Collaborations to Address the Needs of All Communities

Photo of participants at conference

Shared expertise at national, state, and local conferences and in international journals on topics including tobacco-free workplaces, integrated care in schools, 911/mental health service integration, programmatic changes through data, our 24/7 Helpline, and suicide prevention
Expanded outreach to minority communities, launching first-ever BIPOC mental health video series in 6 languages, monthly forums on black mental health, all Spanish-language community forum on mental health, and bi-lingual suicide prevention videos
Bolstered the mental health of our community with a mental health toolkit, a bi-lingual self-care campaign that reached over 100,000 people and virtual forums that reached over 9,000 people; in collaboration with Texas Health and Human Services, NAMI Central Texas, WhatsInTheMirror?, Caritas of Austin, and American Foundation for Suicide Prevention
Collaborated with Kids Living Well to launch a 5-year update to Travis County Plan for Children’s Mental Health and Substance Misuse, a community-wide plan to support the mental health and well-being of Travis County children and youth

I am truly proud of our team and the progress and accomplishments our agency achieved this year. Integral Care is looking ahead to a bright 2022 as we strive to achieve our vision of Healthy Living for Everyone in Austin-Travis County.

David Evans
Chief Executive Officer

Highlights

Using Data to Change the Culture of Behavioral Health Care

One key strategy to achieving racial equity in health and health care is utilizing data to identify, monitor and respond to racial disparities. Integral Care is working to identify and address gaps in data, ensuring that racial equity data is tracked and monitored for all programs, workforce, and services. This data will allow us to thoroughly review service delivery and ensure equitable access to prevention, treatment and recovery services.

Integral Care’s Diversity and Inclusion Council has worked with our Population Health Administrator to develop a Health Disparities Report Card. The report card covers 19 health conditions and risk factors, and is stratified by service division, gender identity, race/ethnicity, and primary language, to identify health disparities specifically within the Integral Care client population. Conditions analyzed include mental health and substance use diagnoses, chronic medical conditions, high risk drivers such as homelessness, hospitalization, justice involvement, and tobacco use; as well as mortality rates and COVID-19 infection rates.

With that report card and other tools, we are using data to investigate potential inequities and gaps in care across the system, and to enact change across the agency, including an effort to identify and mediate diagnostic racial disparities among African American, Hispanic/Latinx, Indigenous, and Asian American/Pacific Islander clients.

Progress Made for Children and Youth

This fall, Integral Care’s Population Health Administrator produced an analysis of oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses among children and youth. Studies indicate that diagnostic and implicit bias contribute to higher rates of these diagnoses among racial minorities, leading to differences in diagnosis and appropriate treatment. As of August 2020, Integral Care’s service data reflected this disparity with Hispanic children representing more than half of all active ODD and CD diagnoses and African American children representing one-third of all such diagnoses. In any given year, two-thirds of all ODD and CD diagnoses are assigned to Black, Indigenous, and People of Color (BIPOC) clients.

Teen talking with a counselor

Informed by this data, Integral Care launched new clinical initiatives to address diagnostic disparities among BIPOC youth. Since 2019, the rate of diagnoses assigned to BIPOC clients has decreased by 11%. This year, the overall rate of new oppositional defiant disorder and conduct disorder diagnoses dropped, with the largest decreases observed among BIPOC children and youth, decreasing the disproportionality gap.

Clinical initiatives include

audits conducted by our Associate Medical Director for Child and Family Services, Dr. James Grubbs, to ensure appropriate diagnosis
a monitoring process to ensure youth and adolescents are sent for psychiatric evaluation as follow-up to any new diagnoses of ODD or CD to prevent misdiagnosis
engaging clinical staff in ongoing conversations around racial equity and culturally competent care
launching interventions to combat employee burnout, which literature has shown can contribute to implicit bias
a process for conducting differential diagnoses to rule out disorders such as ADHD, disruptive mood dysregulation, major depressive disorder, and PTSD prior to making a diagnosis of ODD or CD

Progress Made for Criminal Justice Involved Clients

The Population Health Administrator also performed an in-depth analysis of the 1,417 criminal justice involved individuals served by our ANEW and Mental Health Bond programs in Fiscal Year 2020. ANEW provides mental health support for adults on probation or parole. The Mental Health Bond Program helps people who are currently in the county jail by providing treatment alternatives to incarceration.

Multiple studies on implicit bias have shown that Black patients are more likely to be (mis)diagnosed with schizophrenia than non-Hispanic white patients when accounting for symptomatology using standardized diagnostic criteria. The chart below shows the racial disparity in our client population.

We presented our findings to leadership from Travis County Probation, Travis County Pre-Trial Services, Texas Department of Criminal Justice Parole and Travis County Jail and initiated conversation about strategies to address the array of racial disparities in the local criminal justice system of care. Since the study was completed, we have:

implemented additional screening tools to further assess prevalence of trauma and ensure accuracy of diagnostic evaluations, including Adverse Childhood Experiences screener and Quality of Life surveys
identified and re-evaluated cases to ensure accuracy of diagnoses
expanded counseling services, implementing the following evidence-based & trauma-focused approaches: EMDR, Art Therapy and Sandtray Therapy
revised anger-management curriculum, using best practices and concepts from interpersonal neurobiology, motivational interviewing, and cognitive behavioral therapy

We are beginning to address diagnostic disparities, including the high prevalence of schizophrenia amongst people of color, by utilizing data to track progress and continue to assess the need for trainings, collaborations, and changes for the ANEW and Mental Health Bond programs.

Addressing disparities in health and health care is important not only from an equity standpoint, but also for improving health more broadly by achieving improvements in overall quality of care and population health. This is all part of our vision of Healthy Living for Everyone.

911 Collaboration Featured on 60 Minutes

60 Minutes recently highlighted the work Integral Care and the Austin Police Department are doing to help ensure people experiencing a mental health crisis get the right care at the right time. Their report examined how American cities can reimagine police departments, with Austin as a leading example.

So far this year, 5,048 calls to 911 have been transferred to Integral Care clinicians embedded on the 911 Call Center floor. We diverted over 80% of those calls from police response. With our experts answering mental health calls, police are left to focus on public safety. Here’s what a recent caller had to say about her experience. She called during a family intervention for her daughter.

I didn’t know what was going to happen calling 911. The clinician was so knowledgeable, and I felt like I had someone there, right there with me. I don’t know what I would’ve done without her. She was the calm in the storm, guiding my entire family through the most chaotic and emotional day. That call is what got my daughter to go for psychiatric treatment voluntarily.

It was exactly 2 years ago that our Expanded Emergency Mobile Crisis Outreach Team began taking calls at the 911 Call Center. In February of this year, Austin became the first in the nation to add mental health to the 911 caller prompt menu, asking, “Are you calling for police, fire, EMS or mental health services?” Integral Care is honored to be part of Austin’s emergency system of care.

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