integrating behavioral health and primary care: a clinical model
TRANSCRIPT
Integrating Behavioral Health Integrating Behavioral Health and Primary Care: A Clinical and Primary Care: A Clinical
Model Model Parinda Khatri, Ph.D.
Director of Integrated Care
Cherokee Health Systems
Our MissionOur Mission
To improve the quality of life for our patients through the integration of
primary care, behavioral health and substance abuse treatment and prevention
programs.
Together…Enhancing Life
Cherokee Health SystemsCherokee Health SystemsSERVICESSERVICES
Behavioral HealthAdult OutpatientAdolescent & Family Outpatient Child DevelopmentAlcohol & Drug Abuse OutpatientIntensive Case ManagementHUD Group HomesForensic EvaluationsConsultation & EducationSchool PsychologyCrisis InterventionEarly InterventionCommunity Health Outreach
Dental ServicesPrevention ServicesExtractionsX-RayAmalgamsPalliative Care
Primary CarePediatric & Adult Medical ServicesEarly Childhood Evaluation, Assessment & TreatmentWell Baby Check-upsFamily PlanningGynecological CareComplete Physical ExamsRoutine Laboratory TestsX-RayPreventive Health ServicesBehavioral Health Consultation
Corporate Health StrategiesEmployee Assistance ProgramsHealth Incentive ProgramsManagement Team Development
Integration at Cherokee Health Integration at Cherokee Health SystemsSystems
Comprehensive health care system with a 25 year history of outreach and consultation
Our mission is integrated health services delivery 11 sites with integrated primary and behavioral
services Behavioral health consultation into the region's
primary care safety net providers Integrated care across the lifespan
What is Integrated Care?What is Integrated Care?
"Integrated Care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve the services in relation to access, quality, user satisfaction and efficiency." WHO European Office for Integrated Health Care Services. Integrated Care. Working Definition. 2001
Why Integrate?Why Integrate?
Behavioral and Psychosocial factors in etiology and treatment of physical disease
Primary Care as the locus of treatment for mental health disorders
Financial AdvantagesImproved quality of carePatient satisfactionImproved provider satisfaction
Mental Healthcare in USMental Healthcare in USStrosahl, K. (1996) Primary Mental Healthcare: New model for integrated services, Strosahl, K. (1996) Primary Mental Healthcare: New model for integrated services, Behavioral
Healthcare Tomorrow, October, 93-96. , October, 93-96.
Specialty
Primary Care
None
Integrated CareIntegrated Care
• Illustrates Biopsychosocial model• Meets patients “where they are”• Unifies medical and mental health practice
A Framework to Integrated CareA Framework to Integrated Care
Behavioral Health is ROUTINE component of medical care
Shifting Boundaries of Care• Location
• Staffing
• Skills
Scope of Integrated Care• Horizontal Integration
• Vertical Integration
Co-location and DesignCo-location and Design
Offices for behavioral providers in primary care area
Behavioral consultation in the medical exam room
Shared common areas for patients and providers
Communication ModelCommunication Model
Co-location and DesignPaperflowIntegrated ChartsRegular, face to face verbal feedbackBrief consultationsFormal treatment team/case conferencePhone/Telemedicine Consultation
Clinical ProtocolsClinical ProtocolsScreening Assessment Follow-up and MonitoringEvidence-based clinical guidelines Provider trainingsConsultation with “Specialists”
Levels of Integrated CareLevels of Integrated Care
Level 1 – Consultation, brief targeted interventions, and management in primary care setting
Level 2 – Time limited focused interventions in primary care setting
Level 3 – Referral for longer term therapeutic interventions with collaboration with primary care
Clinician CharacteristicsClinician Characteristics
Match primary care pace and style
Respect cultural differences
Be FLEXIBLE
Communication skills
Consultant skillsTeam Player Be visible and
available
Clinician SkillsClinician Skills
Knowledge of Integrated Care Model
Strong traditional clinical skills
Bio-psycho-social model of health
Brief, creative, and effective treatment
Evidence-based Treatment
Prevention and Patient Education
ObstaclesObstacles
Lack of acceptance of model Paradigm shift for Medical Providers,
Mental Health Providers, and PatientsPractical considerations--location, financesLack of trainingResources
Meeting ChallengesMeeting Challenges
Training Sessions for StaffSpaceInternal Training ProgramsTargeted RecruitmentFinancing
Lessons LearnedLessons Learned
Define Mission and Philosophy of Integrated Care and Share with Everyone
Administrative, Clinical, Support Staff Buy-In
Have Champions at Every LevelMake Change Systematic and OrganizedContinually Re-Evaluate and RespondView Integration as Ongoing Process
Lessons Learned IILessons Learned II
Work as a Team – Communicate and Coordinate
Select Staff CarefullyBe Creative and Innovative
Getting Started: IGetting Started: I
Identify Patient, Provider, Clinic NeedsAssess readiness to changeUnderstand the system (clinical,
operational, financial)
Getting Started: IIGetting Started: II
Behavioral provider must be on-site, highly visible and accessible in the medicine practice area
Behavioral provider must be able to address full range of needs-horizontal and vertical strategies
Behavioral and Medical providers must be committed to the philosophy and principles of integrated care
Getting Started: IIIGetting Started: III
Be realistic about time requiredClarify details (e.G. Charting, billing,
referrals)Involve ALL staff in processScheduling Space: “the final frontier”Mimic the pace of primary care
Future GoalsFuture Goals
Refine and implement integrated care model based on clinical needs
Prevention and Health PromotionIntegrated care network TrainingExpand Telehealth Consultation