• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
IBHC PowerPoint
 

IBHC PowerPoint

on

  • 803 views

 

Statistics

Views

Total Views
803
Views on SlideShare
803
Embed Views
0

Actions

Likes
0
Downloads
1
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • One stop = less transportation and co-pay, more convenience
  • One stop = less transportation and co-pay, more convenience
  • (…able to apply a wider array of interventions): Use and management of medications especially. (shifts focus of care towards longitudinal rather than acute): encourages ct’s to remain engaged in tx and maintenance activities.
  • One stop = less transportation and co-pay, more convenience
  • Behavioral and Physical Health Professionals differ in theoretical perspectives, professional language, and practice style. Is likely to = inconsistency in assessment, tx, recommendation, and referral. Disagreement between providers can affect client confidence in providers. For organizations that already have separate facilities for treating behavioral and physical health problems, trying to make services available in one central location is expensive and time consuming When more than one provider meets with a client, which provider bills insurance? How do providers bill/get paid? Separation of funding sources, especially in managed care model.
  • Behavioral and Physical Health Professionals differ in theoretical perspectives, professional language, and practice style. Is likely to = inconsistency in assessment, tx, recommendation, and referral. Disagreement between providers can affect client confidence in providers. For organizations that already have separate facilities for treating behavioral and physical health problems, trying to make services available in one central location is expensive and time consuming When more than one provider meets with a client, which provider bills insurance? How do providers bill/get paid? Separation of funding sources, especially in managed care model.
  • For instance, a pregnant woman screened for alcohol use by her primary care physician would be treated for substance abuse through her primary care setting for the duration of her pregnancy.
  • Source: D. Perry, personal communication September 2008.
  • Source: D. Perry, personal communication September 2008.
  • Decreased medical health care utilization could indicate the client has less access to a provider or is not receiving effective care that encourages continuation of treatment, and financial costs of providing services reflect outcomes from provider’s point of view not necessarily the quality or effectiveness of treatment.
  • = Decreased power differential
  • Take care of mom/dad/caregiver to create better care for child Cultural awareness/competency essential when treating holistic individual, or when unit of care is the family.

IBHC PowerPoint IBHC PowerPoint Presentation Transcript

  • Integrated Behavioral Healthcare: Effectiveness and Feasibility Technical Assistance Center for Children’s Services (UTACCS) Allison Blaine and Kelly C. Feller September 24, 2008
  • Outline
    • What is Integrated Behavioral Healthcare (IBHC)?
    • Strengths of IBHC
    • Weaknesses of IBHC
    • Models of IBHC
    • Limitations of Research
    • Implications
    • Suggestions for further research
  • What is Integrated Behavioral Healthcare?
    • Collaboration and/or co-location of medical and behavioral health services in effort to more fully address the needs of an individual client.
    • Services usually include evaluation and treatment of both scheduled and walk-in clients.
    • Has been used in rural hospitals, health departments, rural HMOs, rural physician practices, and pre-natal health clinics.
    • Umbrella term that encompasses numerous models
  • Strengths
    • Access
    • Outcomes
    • Provider Experience
  • Strengths
    • Access
      • “ One-Stop Shopping.”
      • Discrete and appropriate referral to necessary care.
      • Increased access to youth clients through well-child care and sick visits.
      • Social safety, less stigma.
      • Pediatricians are vital gatekeepers to specialized care such as behavioral health services
  • Strengths
    • Outcomes
      • A wide body of evidence indicates IBHC is associated with positive outcomes, especially in populations with limited access to care.
      • Sutliffe (2008) found participants in IBHC scored higher on measures of functioning at discharge than individuals in non-IBH systems.
  • Strengths
    • Outcomes
      • What exactly is responsible for positive outcomes in IBHC?
        • Increased access to care = earlier intervention.
        • Varied providers bring diverse knowledge to the “table,” able to apply wider array of interventions.
        • Clients more likely to access non-medical health care when behavioral health clinicians are involved in primary care.
        • Shifts focus of care towards longitudinal rather than acute
  • Strengths
    • Provider Experience
      • Even when there is no difference in convenience for clients, providers still prefer to have behavioral health integrated into the primary healthcare setting .
  • Weaknesses
    • Disconnection between medical and behavioral systems of care.
    • Lack of funding, existing separate facilities, and lack of space are barriers to co-located services.
  • Weaknesses
    • Billing, insurance, and funding issues are especially necessary and complicated
    • Often, caseload must be decreased to allow professionals ample consultation & training time.
  • Models of IBHC
    • Two Categories of IBHC Models
      • Targeted
      • Non-Targeted
  • Targeted Models
    • Provide services to clients experiencing specific concerns, such as pregnant women diagnosed with substance abuse.
    • Qualifying individuals referred to a medical treatment team with specialized knowledge in that particular area.
    • Medical treatment team is often trained by outside mental health professionals who regularly visit the medical office.
  • Non-Targeted Models
    • Provide both physical and behavioral health services to all clients
    • Use of a case management approach that identifies specific client needs, and specific provider(s) to address those needs.
  • Non-Targeted Models
    • Physicians oversee physical well being, behavioral health professionals oversee mental well being.
    • Clients have access to services within the IBHC, such as time-limited therapy and medication management, and when necessary are referred to outside community supports for services not available through the IBHC system.
  • Targeted Model IBHC Programs
    • Primary Mental Healthcare (PMH) Model
      • Developed by Stroshaul in 1998
      • Clients are primary seen by primary care physician who calls on behavioral health professionals to support interventions of the primary care physician.
  • Targeted Model IBHC Programs
    • Primary Mental Healthcare (PMH) Model
      • Level of behavioral health professional’s involvement depends on needs of primary care physician
      • Sessions involving both kinds of professionals are regarded as temporary co-management of the client.
      • Often primary care physicians will develop a treatment plan that integrates the recommendations of a behavioral health professional.
  • Targeted Model IBHC Programs
    • Preemptive training to primary care physicians .
      • Enable physicians to treat specific behavioral health concerns without further consultation with behavioral health clinicians.
      • Different than PMH model (last slide) because training is provided before the physician screens a client for behavioral health issues.
      • In a cluster-randomized study of 58 providers, preemptive primary care physician training facilitated physician ability to reduce impairment of both child and caregiver (Wissow et al., 2008)
  • Non-Targeted Model IBHC Programs
    • The Four Quadrant Clinical Integration Model (FQCIM)
      • Developed by the National Council for Community Behavioral Healthcare
      • On intake, clients are assessed for physical and behavioral health risk then grouped into one of four quadrants
        • Quadrant I: Low B and P health risks
        • Quadrant II: High BH risk, low PH risk
        • Quadrant III: Low BH risk, high PH risks
        • Quadrant IV: High BP risk, high PH risks
  • Non-Targeted Model IBHC Programs
    • The Four Quadrant Clinical Integration Model (FQCIM)
      • Client receives services from providers specifically geared to the individual’s level of physical and behavioral health risk.
      • Clients with mild-moderate behavioral health risks are seen in the primary care setting. Clients with more severe impairments are referred to off-site specialty care services.
      • In a community health organization, the FQDIM yielded “a number of positive and enduring outcomes” (Reynolds, Chesney, and Capobianco, 2006).
  • Non-Targeted Model IBHC Programs
    • The Primary Mental Healthcare Clinic model (PMHC)
      • Uses clinic as a central hub to link clients with various specialized providers in one location
      • Clients screened for mental and physical illness in all visits to primary care provider.
      • If screening indicates behavioral health risk, clients are referred to co-located mental health services.
  • Non-Targeted Model IBHC Programs
    • The Primary Mental Healthcare Clinic model (PMHC)
      • Behavioral and physical health professionals meet with client to create a collaborative treatment plan addressing all health needs.
      • In a large Vermont Veteran’s Clinic, PMHC model was associated with “greater proportion of patient who had screened positive for depression obtaining some depression treatment” and “an increase in guideline-adherent…treatment for depression.” (Watts et al., 2008)
  • Non-Targeted Model IBHC Programs
    • The Great Start Minnesota Project
      • A statewide consultation network for pediatric mental health care professionals.
      • Physicians, behavioral health providers, and educational professions trained on evidence-based intervention/screening for early childhood behavioral health disturbances.
  • Non-Targeted Model IBHC Programs
    • The Great Start Minnesota Project
      • Clinic based behavioral health clinicians provide consultation and services in collaboration with the primary care physician.
      • The St. Cloud model is an extension of Great Start Minnesota Project
        • Involves school-based crisis therapists, access to emergency child psychiatry sessions, and education of school professionals on children’s mental health
        • Decreased total hospital spending by more than $400,000 between 2000 and 2004.
  • Non-Targeted Model IBHC Programs
    • Medical Home (MH) model
      • Aims to provide “accessible, family-centered, continuous, comprehensive, compassionate, developmentally appropriate, coordinate, culturally competent, and accountable” care.
      • Emphasis on preventative care, anticipatory guidance, early intervention, and appropriate use of specialists in conjunction with community based organizations (schools, WIC, Head Start, etc…)
  • Non-Targeted Model IBHC Programs
    • Medical Home (MH) model
      • Family is unit of care
      • Assumption that if caregiver/child environment is not optimally functional, than child is not optimally functional.
  • Limitations of Research
    • Outcome measures
      • Medical health care utilization
      • Financial cost of providing services
    • Sparse information about effectiveness of treatment, symptom reduction, increased functioning, and other client focused outcome.
  • Implications
    • Co-locate services.
    • Become familiar with providers and services to which clients are referred.
    • Establish creative, innovative ,and legitimate billing practices.
    • Train incoming providers in existing program functioning, history, and protocol.
  • Implications
    • Implement policies aimed at building and maintaining positive relationships between behavioral and physical health providers.
      • Refer to all professionals as clinicians whether the individual is a physical or behavioral health professional.
      • Allow ample time for clinicians to consult with other providers
      • Share medical record systems, encourage “open door/open phone” policies with colleagues, and allow e-mail access to consultation.
  • Implications
    • Address the physical and mental well being of each child’s caregiver.
    • Strive for cultural awareness and competency.
  • Questions for Additional Research
    • How effective are different models of IBHC?
    • How does the interplay between specific providers, delivery systems, and client populations effect outcomes of IBHC services?
  • Thank You
    • www.UTACCS.org for more information