introduction to behavioral health integration · 2018-10-11 · define behavioral health...
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Introduction to Behavioral Health Integration
Guilford Prickette, Senior Learning and Development Clinical Advisor
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▪ Define behavioral health integration
▪ Explore existing models of integration
▪ Describe behavioral health integration at SCF and where it is implemented in our system
▪ Explain brief intervention
▪ Explore the common clinical issues addressed, and the standard screening tools used
Objectives
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What are your expectations during this session?
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What is Behavioral Health Integration?
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Where Do People Seek Behavioral Health Services?
General HealthMental Health Professional
Human Services Organizations
Alternative Options
Internet No Services
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Mental Health Disorders
Major Depressive
DisorderPTSD
Alcohol Dependence
Anxiety Disorders
Personality Disorders
Top Diagnoses
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Collaborative Care
Medical Behavioral Specialty
Shared goals and vision, but no financial or operational infrastructure
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Integrated Care
Clinical Operational
FinancialStructural
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▪ Relationships
▪ Greater Awareness
▪ Physical-Behavioral Connection
▪ Increased Access
Why Integrate Behavioral Health?
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▪ Flexible communication
▪ Recruiting and training
▪ Orientation and training of primary care providers
▪ Medical and behavioral charting
▪ Proximity
▪ Maintaining strong connection between behavioral and medical health
▪ Level of consultation and referral
▪ Operational
Behavioral Health Integration
Key Elements
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Levels of Integrated Care
SAMSHA-HRSA Center for Integrated Care Solutions
Level Collaboration
1 Minimal
2 At a distance
3 Basic – onsite
4 Close – onsite with some system integration
5 Close – approaching an integrated practice
6 Full – transformed/merged into integrated practice
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What is your organization’s current level of integrated care?
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▪ Diversification/Primary Care Behavioral Health
▪ Co-Location
▪ Referral
▪ Enhancement
▪ Chronic Care
▪ Reverse Integration
Models of Integration
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Behavioral Health Integration at Southcentral Foundation
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Traditional Behavioral Health System
Primary Treatment Pathways
Scheduled Individual Therapy
Medication Management
Behavioral Urgent
Response Team
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▪ Goal• Meet the behavioral health needs of customer-owners
▪ Actions• Mental health clinicians hired as Behavioral Health Consultants
and integrated into primary care clinics 13 years ago
• Started small with two Behavioral Health Consultants
• With success, demand increased
• Number of Behavioral Health Consultants increased to meet demand
History of Behavioral Health Integration at SCF
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Integrated Care
EHR
BehavioralMedical
Present IntegrationEarly Integration
EHR
BehavioralMedical
A Framework
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ClinicNumber of
Behavioral Health Consultants
Primary Care Clinics-Anchorage, AK 16
Primary Care Clinic-Mat-Su Valley - Wasilla 5
Primary Care Clinic-Pediatrics 5
Behavioral Health Clinics 4
Hospital 2
Rural Community Health Centers (CHC) 4
Integration Across SCF
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Behavioral Health Integration
Social Work
Acute Care
Motivational Interviewing
Screening Psych-Ed Brief Intervention
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Scope of Integration
Primary Care Team
Registered Nurse
Registered Dietician
Medical Assistant
Case Manager
Behavioral HealthConsultant
Provider
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Clinical Levels of Integrated Care
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Approach to Care
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Two Approaches to Clinical Work
▪ Customers present with a range of concerns
▪ Meet customers where they are at
▪ Help to improve customer’s overall health
▪ Example: customer presents with chest pain, medical rule out, focus on stress, grief, situational stress, etc.
▪ Work with specific subpopulations
▪ Targeted interventions for these
populations
▪ Define treatment protocols and clinical guidelines
▪ Example: depression screening and follow-up
Not Targeted Targeted
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Phases of a Brief Intervention
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▪ Depression
▪ Anxiety
▪ PTSD/Acute Stress
▪ Childhood Behavioral Concerns
▪ Parent Coaching
▪ Substance Abuse
▪ Grief
Integrated Primary Care Setting Clinical Topics
▪ Sleep Hygiene
▪ Traumatic Brain Injury
▪ Psychosocial Stressors
▪ Family and Relational Stress
▪ Specific Age or Gender Related Concerns
• Women
• Children
• Elders
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What are the most commonissues in your organization?
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What We Assess
•PrimeMDDepression
•AUDIT, CRAFFTSubstance Use
•MMSECognition
•ASQ, SE, M/CHAT, SDQ, VanderbiltDevelopment
•PPP, MBMD, SCL-90, P-3Chronic Pain
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▪ Motivation for lifestyle change
▪ Breaking down the goals into manageable steps
▪ Addressing co-occuring conditions such as anxiety, depression, or sleep disorders
▪ Providing support for providers
▪ Managing provider expectations regarding realities of behavior change
Chronic Disease Management
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• Pain consultant
• Structured behavioral health referral process
• Wellness care plans
• Primary care provider coaching
• Integrated psychiatry
Advanced BehavioralHealth Integration
Primary Care Clinics
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▪ Brief intervention in traditional behavioral health clinic
▪ Brief intervention in hospital clinics
▪ Brief Intervention and combination therapy/integrated substance abuse assessment in rural clinics
Other Behavioral Health Consultant Frameworks at SCF
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Questions?
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Háw'aaHaida
Mahsi'Gwich’in Athabascan
IgamsiqanaghalekSiberian Yupik
T’oyaxsmTsimshian
GunalchéeshTlingit
QuyanaYup’ik
Tsin'aenAhtna Athabascan
Chin’anDena’ina Athabascan
QaĝaasakungAleut
QuyanaqInupiaq
Awa'ahdahEyak
QuyanaaAlutiiq
Thank You!