Cascadia has recently been selected as a recipient of the Reverse Integration Grant by Cambia Health Foundation, the corporate foundation of Cambia Health Solutions. Founded in 2007, the Cambia Health Foundation has funded over $60 million in grants to advance patient-focused and family-oriented care for all.

People with severe and persistent mental illness (SPMI) experience grave health disparities, dying three decades earlier than the general population, on average. People with mental illness are also more likely to be high utilizers of hospital emergency rooms. These tragic statistics, largely attributed to complications of unmanaged chronic disease, have remained true even after innovative transformations in primary care delivery over the last decade.

For Cascadia, it has become a priority to find a way to reverse these disparities and serve our community’s most vulnerable. Over the last two years, Cascadia has recruited leading primary care professionals to integrate patient centered primary care into three outpatient behavioral health clinics with great success. Cascadia is now ready to test and implement these innovations in residential programs where homeless and low income people with severe and persistent mental illness (SPMI) are experiencing the greatest barriers to health.

Funding from the Reverse Integration Grant will support an innovative pilot in which primary care will be “reversely integrated” into a community behavioral health residential setting serving individuals with SPMI who are transitioning out of homelessness. The pilot project will take place at Cascadia’s Prescott Terrace facility, which provides fifty units of permanent supportive housing to an average of 70 tenants per year.

Prescott Terrace operates as the first point of return for individuals with mental illness who have been homeless and on the streets. Most clients who live at Prescott have spent decades on the streets and enter Prescott with substantial physical and behavioral health challenges. In this setting, tenants re-learn to live indoors and receive flexible housing supports the facility provides, with the goal of eventually transferring to a more independent living facility. Historically, Prescott Terrace residents utilize the emergency department at a disproportionally high rate and experience high turnover, making it an ideal setting to implement new, innovative integrated healthcare practices.

Individuals included in the pilot will participate in a baseline physical health assessment and receive primary care and wellness services with the goal of improving health and behavioral conditions. Cascadia anticipates the care given in the pilot will reduce the utilization of the emergency department among participants, allowing these individuals to improve their well-being and live healthier, fuller lives.

In alignment with the goals of this grant, Cascadia looks at the whole person and believes that an integrated healthcare approach is the best way to serve our clients. Integrated care produces the best outcomes and is the most effective approach to caring for people with complex healthcare needs, such as the individuals that will be included in this program. Looking forward, Cascadia hopes adapt the lessons learned in this pilot across the 70 other Cascadia housing facilities, as well as encourage the use of similar methods in the facilities of other health and housing organizations in the community.

To learn more about Cascadia’s integrated healthcare model, visit: https://cascadiahealth.org/integrated-healthcare/.