Cssi Ppt Portland Family Practice


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Cssi Ppt Portland Family Practice

  1. 1. <ul><li>Integrating Mental Health into the Medical Home </li></ul><ul><li>May 2011 </li></ul>Portland Family Practice
  2. 2. Aim <ul><li>Improve screening, identification, and treatment referral for adult and adolescent patients who are high risk for substance abuse and depression </li></ul>
  3. 3. Objectives <ul><li>Hire mental health professional for expertise and assistance with program development </li></ul><ul><li>Integrate mental health professional into existing family practice model </li></ul><ul><li>Identify patients who are at risk for depression & substance abuse; assess co-morbidity </li></ul><ul><li>Provide mental health services directly or refer to appropriate outside providers </li></ul>
  4. 4. Hiring for the right fit <ul><li>Hired licensed psychologist, Pat Blumenthal, PsyD </li></ul><ul><ul><li>Experience in providing individual & family therapy </li></ul></ul><ul><ul><li>Experience with using screening tools and collection of outcome data </li></ul></ul><ul><ul><li>Experience with managed care and insurance </li></ul></ul><ul><ul><li>Experience in program development </li></ul></ul>
  5. 5. Teamwork <ul><li>Coordinated efforts with: </li></ul><ul><li>Information Technology </li></ul><ul><li>Physicians & Medical Assts </li></ul><ul><li>Intake/Triage </li></ul><ul><li>Case managers in Medical Home </li></ul><ul><li>Front Office staff </li></ul><ul><li>Schedulers </li></ul><ul><li>Billing & Benefits </li></ul>Reporting Coordination of Services Training Referrals IT Workflow Set up Mental Health
  6. 6. Objectives & Measures <ul><li>All patients given the PHQ-9; teens given additional CRAFFT </li></ul><ul><li>Scores documented in medical record </li></ul><ul><li>Scores above threshold identified for mental health referral </li></ul>
  7. 7. PHQ-9 Questions <ul><li>1. Little interest or pleasure in doing things </li></ul><ul><li>2. Feeling down, depressed, or hopeless </li></ul><ul><li>3. Trouble falling or staying asleep, or sleeping too much </li></ul><ul><li>4. Feeling tired or having little energy </li></ul><ul><li>5. Poor appetite or overeating </li></ul><ul><li>6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down </li></ul><ul><li>7. Trouble concentrating on things, such as reading the newspaper or watching television </li></ul><ul><li>8. Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual </li></ul><ul><li>9. Thoughts that you would be better off dead, or of hurting yourself in some way </li></ul>
  8. 8. CRAFFT Questions <ul><li>C—Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs? </li></ul><ul><li>R—Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? </li></ul><ul><li>A—Do you ever use alcohol/drugs while you are by yourself, ALONE? </li></ul><ul><li>F—Do you ever FORGET things you did while using alcohol or drugs? </li></ul><ul><li>F—Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? </li></ul><ul><li>T—Have you gotten into TROUBLE while you were using alcohol or drugs? </li></ul>
  9. 9. Visibility <ul><li>Methods of Promoting Awareness of Mental Health Services </li></ul><ul><ul><ul><li>Screening tools given to patients </li></ul></ul></ul><ul><ul><ul><li>Dialogue between PCP – Patient about mental health issues </li></ul></ul></ul><ul><ul><ul><li>Posters in all exam rooms </li></ul></ul></ul><ul><ul><ul><li>Website presence with Mental Health blog </li></ul></ul></ul><ul><ul><ul><li>“ Curbside Counseling”, seamless introductions </li></ul></ul></ul>
  10. 10. Mental Health Services <ul><li>PCPs give patient recommendation for counseling based on score. </li></ul><ul><li>For many patients, PCP offers chance to meet Dr. Blumenthal to make initial contact or to schedule appointment before leaving office. </li></ul><ul><li>If unable to meet initially, Dr. Blumenthal contacts the patient by phone to offer services. </li></ul>
  11. 11. PHQ-9 Results
  12. 12. CRAFFT Results
  13. 13. Lessons Learned <ul><li>Hiring </li></ul><ul><li>Credentialing & Insurance Issues </li></ul><ul><li>Training & workflow </li></ul><ul><li>Provider Involvement </li></ul><ul><li>Confidentiality </li></ul><ul><li>IT challenges </li></ul><ul><li>CRAFFT (parents) </li></ul><ul><li>Consistency </li></ul>
  14. 14. Identification & Referral underway <ul><li>In-house treatment </li></ul><ul><li>Phone outreach </li></ul><ul><li>Tracking </li></ul><ul><li>Referrals </li></ul><ul><li>Re-test </li></ul>
  15. 15. Success Stories <ul><li>59 year old breast cancer patient </li></ul><ul><li>52 year old female with recent suicide attempt </li></ul><ul><li>28 year old male, unable to work </li></ul>
  16. 16. <ul><li>Follow up - Therapy outcomes </li></ul><ul><li>Utilization patterns </li></ul><ul><li>Continued outreach </li></ul>Next Steps
  17. 17. Project Team <ul><li>Bunny Meharry, RN, BA </li></ul><ul><ul><li>Clinical Operations Manager </li></ul></ul><ul><li>Cindi Bourn </li></ul><ul><ul><li>MA/IT EHR Manager </li></ul></ul><ul><li>Pat Blumenthal, PsyD </li></ul><ul><ul><li>Clinical Psychologist </li></ul></ul>Delete this text box and add your organization’s logo here