Key Note: Michelle Duprey, LMSW • Integrating Mental Health Care into other Child Systems

1. Creative Integrated
Health Care
The Expansion of the IHC model to other settings
Michelle Duprey, LMSW
Director, Integrated Health Care
Starfish Family Services
Michelle Duprey, LMSW Starfish Family Services

2. Examples
Medical care in Community Mental Health clinics
Integrated Health Care in Sexual Assault Centers
MC3
Neonatal Abstinence Syndrome
Integrated Infant Mental Health
IHC in Specialty Care
Medical Care Coordination in Community Mental Health
Integrated Health Care in Medical Workforce Development
Michelle Duprey, LMSW Starfish Family Services

3. Integrated
Infant Mental
Health
State of Michigan Endorsed Infant Mental Health
Therapists
• Medicaid units billing
• Bundled service
• Intensive level of care; home visits 2 hours per week
• Decreased caseload of 32/48 units
Embedded in OB/GYN practices
• 2-3 days per week depending on size of clinic and Medicaid
population
• Detect need
• Determine eligibility
• Refer to themselves (improves retention of referrals)
Complete similar Implementation activities
Michelle Duprey, LMSW Starfish Family Services

4. The Behavioral Health
Consultant:
Masters trained
Licensed
Endorsed Infant Mental
Health Therapist
Receives specialty training
and supervision
The Behavioral Health
Consultant:
Embedded on medical team
Provides behavioral health
consultation to the medical
team
Helps the practice to be
trauma equipped
The Behavioral Health
Consultant:
Supports screenings for
toxic stress and trauma
environments
Provides short interventions
Provides psycho-education
Provides resources and
referrals
Integrated Infant Mental Health; an OB/GYN and Behavioral Health partnership
Michelle Duprey, LMSW Starfish Family Services

5. Stress Health
Behaviors
Weight
Management
Grief and Loss
Support
Smoking
Cessation
Mental Health
Crisis
Trauma Pregnancy
support
Pregnancy
Fears
Depression
and Anxiety
Chronic
Disease
Management
Coping Skills Prenatal
Bonding and
Attachment
Domestic
Violence,
Substance
Abuse
Referrals and
Resources
“I HAVE SOMEONE FOR THAT” instead of “YOU’LL HAVE TO GO SOMEWHERE
FOR THAT”
Michelle Duprey, LMSW Starfish Family Services

6. Systems of Care
IHC Work
• Pediatric Integrated Health Care
• Funded by the CMH Authority Systems of Care Block
Grant
• Originally grant funded
• 1 Pediatric Behavioral Health Consultant in 2
medical practices
• Health System Family Medicine practice with
Resident Training
• Urban Health System Pediatric practice
• Pediatric Integrated Health Care Workgroup
• Focus is on how Pediatric CMH providers can
become more Integrated in traditional CMH
work
• Medical Care Coordinator
Michelle Duprey, LMSW Starfish Family Services

7. Medical Care
Coordination
in Community
Mental
Health
Case Manager position
within Community Mental
Health children’s provider
agency
Provides care coordination,
psychoeducation, action
plans, referrals and
resources to children with
identified medical issues
with a high health behavior
or behavioral health
component (Obesity,
Asthma, diabetes and
psychotropic medications)
Coordinates care with
psychiatrist, parent and
pediatrician
Also helps with
coordination of psychiatric
medication transfer of
discharged patients to their
pediatrician
Michelle Duprey, LMSW Starfish Family Services

8. Mental
Health in
Schools
• Prevention: grant funded through CMH
• Weekly groups
• Professional development for school staff on MH issues
• Parent workshops
• Teacher consults
• Crisis intervention
• Traditional
• Enrolled in CMH for Outpatient and/or HB
Starfish Family Services: 2 levels of services
• Team Based approach for maximum integration
• Trails
• https://trailstowellness.org/
Detroit Public Schools
Michelle Duprey, LMSW Starfish Family Services

9. Population
Services
Children/Youth in need of IEP
services
Children/Youth in need of Mild
to Moderate Behavioral Health
Children/Youth with Severe
Emotional Disturbance
Create eligibility criteria for
this population
Create eligibility criteria for
this population
Create eligibility criteria for
this population
Create eligibility criteria for
this population
Create Workflow for
access to this service
Create Workflow for
access to this service
Create Workflow for
access to this service
Create Workflow for
access to this service
Traditional School
Psychologist/Social Work
procedures
Traditional School
Social Work services
Children/Youth in need of Intervention ie:
groups, intermittent intervention (less
than a mild to moderate Behavioral
Health Need)
Referral to Qualified Health Plan
Outpatient services. If you have
a School Based Health Center,
they would be referred there
Referral to the CMH
provider located within the
school for CMH services
Michelle Duprey, LMSW Starfish Family Services

10. Implementation
• Understand roles
• Create champions
• Create pathways together for
deeper dive understanding
Workgroup
with
representation
from each
service area
• Huddles as you go
• Barriers
• Group problem solving
• Brainstorm “exceptions”
• Coordinate care
Meet weekly
for
development
phase and roll
out
Michelle Duprey, LMSW Starfish Family Services

11. Neonatal
Abstinence
Syndrome
• Patients identified in the Labor and Delivery department
of the hospital
• Patients were just referred to a Pediatrician for care
• Pediatrician’s were not equipped to receive the referrals
and provide quality care
• The group used IHC model to create an IHC bridge
(linkagration)
• BHC staff housed at the identified Pediatric clinic
• Hospital staff identified to coordinate with the BHC
staff in the Pediatric clinic
• Warm handoff
• On-going Communication
• Care Coordination: clear pathway was created
for patients
• Pediatric office was better prepared for the
referral
Michelle Duprey, LMSW Starfish Family Services

12. Integrated
Health Care in
Workforce
Development
HEALTH SYSTEM FAMILY
MEDICINE CLINIC WITH
35 RESIDENTS
CLASSROOM AND CLINIC
RESIDENT TRAINING
LUNCH AND LEARNS
COMMUNITY MENTAL
HEALTH ROTATION
PLANS TO EXPAND TO
MEDICAL SCHOOL
CLASSROOM TRAINING
Michelle Duprey, LMSW Starfish Family Services

13. MC3
Michigan Child Collaborative Care program
Funded by the State to University of Michigan
Depression Center to Wayne County Community
Mental Health Authority to Starfish Family Services (a
lot of layers)
1 Pediatric Behavioral Health Consultant embedded in
a Pediatric medical clinic in Detroit
Provides BHC direct services to patients as well as MC3
services
Michelle Duprey, LMSW Starfish Family Services

14. MC3
• The MC3 program provides psychiatry support to primary care providers who are managing patients with
behavioral health problems. This includes children, adolescents, young adults through age 26, and women
who are contemplating pregnancy, pregnant or postpartum with children up to a year.
• Psychiatrists are available to offer guidance on diagnoses, medications and psychotherapy interventions so
that primary care providers can better manage patients in their practices. Support is available through same-
day phone consultations to referring providers as well as remote psychiatric evaluation in select counties to
patients and families through video telepsychiatry.
• The participating Primary Care Provider (PCP) initiates a call to the Behavioral Health Consultant (BHC), a
masters-level mental health professional based locally.
• The BHC triages the referral, responds to any questions that are within the scope of his/her expertise, and
forwards appropriate cases to the MC3 psychiatrist for same day phone consultation
• The psychiatrist will not request any identifying information that would violate the patient’s confidentiality
and does not document in a medical record.
• In some cases, the patient may require a telepsychiatry consultation. Following the consultation, the
psychiatrist will provide feedback to the referring PCP, and the BHC will follow up with recommendations
and referrals.
Michelle Duprey, LMSW Starfish Family Services