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IBHC PowerPoint

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IBHC PowerPoint

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

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