INTEGRATED BEHAVIORALHEALTH IN NEWAYGOCOUNTY – FLYING THE PLANEAS WE BUILD ITDr. Mark Kuiper, MDSarah Bowman, LMSW
Why integrate care?   70% of all PC visits have psychosocial drivers   50% of patient w/diabetes will suffer from    dep...
Why integrate care?   Individuals with serious mental illness die more than    25 years earlier than general population ...
Picture this…..   The woman with chronic pain starts using a few coping    skills and stops abusing her pain meds   The ...
Prior to IBH in Newaygo County….
Now……
How we got here……   Executive Level Support and Space   Getting to know your co-pilots     Meeting   of the Minds     ...
What does our plane look like?   School based clinics   IBH services provided by NCMH clinician at White    Cloud Family...
Our Flight Manual   IBH Clinical Protocol     Referral  Process     Patient flow     Quadrant Model     Documentation
Quadrant Model   Quadrant I       Patients with low behavioral health and low physical health needs       Served in pri...
Newaygo County Mental Health Primary Care Provider Consultation NoteName:Insurance:DOB:Date/Time: Presenting Problem:_____...
Our initial flight data…..   Start date May 18th   136 IBH contacts   19 min is average length of contact   6 NCMH dir...
Referrals By Quadrant Type            Q4 High BH             High PH              18%                     Q1 Low BH       ...
Presenting Physical Health Issue                            Presenting Physical Health Issue                   Sleep      ...
Presenting Behavioral Health Issue                                        Presenting Behavioral Health Issue              ...
“NCMH liaison” Role   45 contacts in September alone!   Two IBH clinicians       Assigned to specific NCMH clinical tea...
“NCMH liaison” Role    Co-located access at WCFHC site    Full access screening is completed at WCFHC at     time of app...
When Turbulence Hits….   Technology     Difficult   to do concurrent documentation   Two Separate Medical Records   Me...
Next Steps   Record Review/Needs Assessment of mutual    consumers/patients   Create collaborative patient/consumer PH a...
Questions?
Sources   Robinson and Reiter 2007   Colton and Manderscheid 2006   Mauer 2006   Kroenke et al 1989   Karen Way 1999...
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Integrated Behavioral Health In Newaygo County – Flying the Plane as we Build It

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When it comes to behavioral health/primary care integration, we are often forced to fly into unchartered areas in an effort to meet the needs of our patients and ongoing health care reform. Newaygo County Mental Health (NCMH) and Family Health Care (FHC) have been working collaboratively since 2010 to provide integrated health care. NCMH clinicians provide outpatient therapy services within two FHC federally funded Teen School-based Health Centers. NCMH recently added two Integrated Behavioral Health Clinicians to the FHC health center in White Cloud. This webinar will provide an overview of how primary care health centers and community mental health centers can partner to improve physical and behavioral health for their community.

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Integrated Behavioral Health In Newaygo County – Flying the Plane as we Build It

  1. 1. INTEGRATED BEHAVIORALHEALTH IN NEWAYGOCOUNTY – FLYING THE PLANEAS WE BUILD ITDr. Mark Kuiper, MDSarah Bowman, LMSW
  2. 2. Why integrate care? 70% of all PC visits have psychosocial drivers 50% of patient w/diabetes will suffer from depression 90% of most common complaints have no organic basis 67% of all psychoactive agents are prescribed by PCP 80% of antidepressants are prescribed by PCP
  3. 3. Why integrate care? Individuals with serious mental illness die more than 25 years earlier than general population Only 1in 4 patients referred to specialty MH/SA make the first appointment Seven of the ten leading causes of death (heart disease, cancer, stroke, chronic lower respiratory disease, accidents, diabetes and suicide) have a psychological and/or behavioral component
  4. 4. Picture this….. The woman with chronic pain starts using a few coping skills and stops abusing her pain meds The man with diabetes starts checking and recording his blood sugars daily and recognizes the impact his food choices are having on his blood sugar. The obese child you have been treating looses 8lbs. 70% of the patients you refer to specialty MH/SA treatment actually follow up and participate in tx. The man with schizophrenia and heart disease starts walking daily and takes his medication as ordered. He even starts eating a few healthy foods daily.
  5. 5. Prior to IBH in Newaygo County….
  6. 6. Now……
  7. 7. How we got here…… Executive Level Support and Space Getting to know your co-pilots  Meeting of the Minds  Identified IBH Champions  Joint Interviews  Flying without a pilot’s license
  8. 8. What does our plane look like? School based clinics IBH services provided by NCMH clinician at White Cloud Family Health Care (WCFHC) Co-located NCMH access at WCFHC NCMH “liaison” role for patients/consumers served by both NCMH and WCFHC
  9. 9. Our Flight Manual IBH Clinical Protocol  Referral Process  Patient flow  Quadrant Model  Documentation
  10. 10. Quadrant Model Quadrant I  Patients with low behavioral health and low physical health needs  Served in primary care setting  Example: patients with moderate alcohol abuse and fibromyalgia Quadrant II  Patients with high behavioral health and low physical health needs  Served in primary care and specialty mental health settings  Example: Patients with bipolar disorder and chronic pain  Note: When mental health needs are stable, often mental health care can be transitioned back to primary care. Quadrant III  Patients with low behavioral health and high physical health needs  Served in primary care setting  Example: patients with moderate depression and uncontrolled diabetes Quadrant IV  Patients with high behavioral health and high physical health needs  Served in primary care and specialty mental health setting  Example: patients with schizophrenia and metabolic syndrome or hepatitis C
  11. 11. Newaygo County Mental Health Primary Care Provider Consultation NoteName:Insurance:DOB:Date/Time: Presenting Problem:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Diagnosis: Axis I:  ____________________________ ____________________________Axis 2:  ____________________________ ____________________________Disposition: Referred  To:  NCMH  Vera’s House  WISE Arbor Circle/ NMSAS  John Bjork  ____________Linked with: Food Pantry  DHS Tru North  _______________________Provided Psychoeducation on: Depression   Positive Parenting Practices  Substance Abuse Anxiety  Communication  Diabetes Anger  Relationships  Smoking Cessation Health/Nutrition  Heart Disease  AsthmaPlan: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________Clinician Signature Date_____________________________________ _________________Primary Care Provider Signature Date
  12. 12. Our initial flight data….. Start date May 18th 136 IBH contacts 19 min is average length of contact 6 NCMH direct referrals 4 referrals to other CMH centers 4 NCMH potential referrals but were not completed (patient not interested in services, guardian not present to seek services, etc)
  13. 13. Referrals By Quadrant Type Q4 High BH High PH 18% Q1 Low BH Low PH 26% Q3 Low BH High PH 14% Q2 High BH Low PH 42%
  14. 14. Presenting Physical Health Issue Presenting Physical Health Issue Sleep Bronchitis Head Injury Cardiac Menopause 3% 1% 1% 1% 4% Asthma Cancer 1% 3% Weight Issues 4% Fibromyalgia 2% Hypertension 5% Chronic Pain 13% Smoking 3% Liver Disease 4% Infant/Child Developent 29% Injury 1% COPD Autism 2% 2% Metabolic Diabetes Pregnancy 1% 7% 5% Arthritis 4%
  15. 15. Presenting Behavioral Health Issue Presenting Behavioral Health Issue Thought RAD Disorder 1%Grief/Loss 1% Personality Disorder Trauma ODD 3% 1% 2% 0% Developmental Disability 2% Substance ADHD Abuse 5% 8% Anxiety Depression 20% 35% Anger 3% Stressors 13% Parenting 6%
  16. 16. “NCMH liaison” Role 45 contacts in September alone! Two IBH clinicians  Assigned to specific NCMH clinical teams  Attend daily or weekly team meetings Primary gatekeeper between NCMH and WCFHC  Records requests  Psychiatric consults  Advocating for NCMH consumer’s physical health needs  Overall care coordination  *Success Story!! A work in progress
  17. 17. “NCMH liaison” Role  Co-located access at WCFHC site  Full access screening is completed at WCFHC at time of appointment with PCP  *Success Story!!
  18. 18. When Turbulence Hits…. Technology  Difficult to do concurrent documentation Two Separate Medical Records Medical Provider’s World View  Behavioral Health?...... To Screen or Not To Screen? Two different funding structures  Billing, coding questions – who is the “go to”person?
  19. 19. Next Steps Record Review/Needs Assessment of mutual consumers/patients Create collaborative patient/consumer PH and BH goals/outcomes Identify specific populations and provide evidence based interventions Securing primary care services for NCMH consumers with no PCP (on site or at FQHC) Billing, Billing, Billing, Billing, Billing Expand – future sites
  20. 20. Questions?
  21. 21. Sources Robinson and Reiter 2007 Colton and Manderscheid 2006 Mauer 2006 Kroenke et al 1989 Karen Way 1999 Centers for Disease Control and Prevention 2005 Contact sbowman@nmch.org for full citations

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