Webinar broadcast on Feb 27, 2019 - 3:00PM EST Delivering behavioral health services as a part of an integrated team is crucial to providing comprehensive primary care services. Focusing on the vital role of behavioral health, experts will share the key elements that maximize the contributions of these team members through structured approaches to screening, the use of “warm hand offs” to ensure connection to primary care, and implementing a robust group of treatment programs to enhance access and improve outcomes. This session will also discuss the day-to-day operation of a behavioral health program and detail the data and clinical dashboard that supports the work of these vital team members. There has been tremendous progress from health centers across the country in the integrating behavioral health, this webinar will share how integrated behavioral health can advance the team’s capability to provide effective and high quality care to complex patient populations.

1. Welcome
We will begin shortly…

2. Disclosure
• With respect to the following presentation, there has been no relevant
(direct or indirect) financial relationship between the party listed above (or
spouse/partner) and any for-profit company in the past 12 months which
would be considered a conflict of interest.
• The views expressed in this presentation are those of the presenter and
may not reflect official policy of Community Health Center, Inc. and its
Weitzman Institute.
• We are obligated to disclose any products which are off-label, unlabeled,
experimental, and/or under investigation (not FDA approved) and any
limitations on the information hat we present, such as data that are
preliminary or that represent ongoing research, interim analyses, and/or
unsupported opinion.

3. Get the Most Out of Your Zoom Experience
• Use the Q&A Button to submit questions!
• Live tweet us at @CHCworkforceNCA
• Recording and slides are available after the
presentation on our website within one week
• View past webinars at www.chc1.com/nca

4. Behavioral Health Staff in Integrated Care Settings
The Vital Role of Behavioral Health:
Effective Integration in a Model of Team Based Care
February 27th, 2019 | 3 p.m. EST

5. The Community Health Center, Inc. and its Weitzman Institute
provides education, information, and training to interested
health centers on:
Transforming Teams
• National Webinars on the team based care model
• Invited participation in Learning Collaboratives to launch team
based care at your health center
Training the Next Generation
• National Webinar series on developing Nurse Practitioner and
Clinical Psychology residency programs and successfully hosting
health profession students in health centers
• Invited participation in Learning Collaborative to implement these
programs at health center

6. CHC Profile:
 Founding year: 1972
 Over 200 service sites
 Patients/year: 100,000
6

7. The Weitzman Institute works to improve primary care
and its delivery to medically underserved and special populations through research,
innovation, and the education and training of health professionals.
Weitzman Institute
7

8. Expert Panelists
Tim Kearney, PhD
• Chief Behavioral Health Officer, CHCI
Vicki Carter, PSY.D, LPC
• On Site Behavioral Health Director, New London and
Groton sites, CHCI
Theresa Wiblishauser, LCSW, Registered Play Therapist
• Behavioral Health Provider and Student Supervisor,
Waterbury site, CHCI
Veena Channamsetty, MD
• Chief Medical Officer, CHCI

9. Objectives
1. Understand the role of behavioral health services in an integrated
team in primary care services
2. Learn the key elements that maximize contributions of these
behavioral health team members
3. Understand structured approaches to screening, the use of “warm
hand offs” to ensure connection to primary care, and the
implementation of a robust group of treatment programs to enhance
access and improve outcomes
4. Understand the day-to-day operation of a behavioral health
program and detail the data and clinical dashboard that supports the
work of these vital team members

10. Polling Question
Do you identify as a medical
professional, behavioral health
professional, or do you have
other professional training?

11. • Nearly 1 in 5 US residents is struggling with behavioral
health (BH) issues
• An estimated 43% to 60% of individuals with BH conditions
are receiving treatment solely in primary care settings
• Researchers estimate between 30% and 80% of all primary
care visits are driven at least in part by BH issues.
Increasingly, integrated BH is seen as an expectation
of primary care.
Landscape
Blasi PR, Cromp D, McDonald S, Hsu C, Coleman K, Flinter M, Wagner E. Approaches to Behavioral Health
Integration at High Performing Primary Care Practices. J Am Board Fam Med. Sept-Oct 2018: 31(5): 691-701.

12. Integrating BH services into primary care can
enhance access to treatment for mental health and
substance use issues reduce costs, improve patient
experiences of care, and improve patient outcomes.
Through BH integration, primary care practices
can identify and address patients’ physical
health, mental health, health behavioral,
substance use, life stressors, and barriers to
wellness.
Blasi PR, Cromp D, McDonald S, Hsu C, Coleman K, Flinter M, Wagner E. Approaches to Behavioral Health
Integration at High Performing Primary Care Practices. J Am Board Fam Med. Sept-Oct 2018: 31(5): 691-701.

13. Polling Question
Using the HRSA
definitions, is your
program offering
coordinated care, co-
located care,
integrated care,
none of the above?
In coordinated care, primary and BH
care are provided at different
locations in the medical
neighborhood, but care is
coordinated through enhanced
communication across the two
disciplines.
In co-located care, primary and BJH
care are offered at the same site, via
referral and use of separate
treatment plans.
In integrated care, BH and primary
care providers work together in a
team and use on treatment plan.
https://www.integration.samhsa.gov/integrated-care-models/Behavioral_Health_Integration_and_the_Patient_Centered_Medical_Home_FINAL.pdf

14. Behavioral Health Practice Models
Integrated BH Practice –
Full BH program of individual, family, and group
therapy and well as med management across the age
range.
Off Site Consultant
• Telepsychiatry
• E-consults
Psychiatric
Consultant
• Works only with PCPS
• Works directly with
patients
BH Consultant
• Warm handoffs
• Health psychology
• STT with referral to
specialty care

16. Are FQHCs sufficiently staffed
to meet our behavioral health
needs?

17. 2017 National Health Center Data
Table 5: Staffing and Utilization
https://bphc.hrsa.gov/uds/datacenter.aspx?q=t5&year=2017&state=
Ratio of Behavioral Health Providers to Patients – 1: 2,842

18. Behavioral Health
Staffing

19. Behavioral Health
Staffing

20. • Train your current staff
• Recruitment
• Build relationships with
training institutions
• Train health profession
students
• Postgraduate residency and
fellowship training
Practice in the very busy and demanding setting of
an FQHC calls for explicit training in the expectations,
communications, workflow, and mutual support that
underlies a highly effective team.

21. How does integrated behavioral health
work in a team-based care setting?
Define your core
team

22. BH Workflow
Behavioral Screening in Medical
There are many pathways to Behavioral Health care, one of the most
robust and reliable is regular screening in medical visits.
Nurses and MA’s can screen for multiple conditions including
• Substance abuse (DAST, AUDIT, SBIRT)
• Depression (PHQ-2/9)
• Domestic Violence (HITS, HARK)
• Patient Symptom Checklist-17
• MCHAT
• and others that you may determine
All of these identify patients who may be in need of support from
Behavioral Health

23. 05/14/2014 23
Warm Hand Offs (WHOs):
Proactive and Reactive
Medical initiated warm hand-off and behavioral health
initiated warm hand-off
• Reactive: Initiated by medical provider
• Proactive: Initiated by BH provider based on EHR
• BH diagnosis and no BH visits
• Clinically significant screening tool
• Specific medical diagnosis
• High risk patient (identify criteria)

24. Behavioral Health Dashboard: Reactive WHOs
Warm Hand Offs or WHO’s exemplify BH and medical integration better than anything else.
• Medical providers have instant access to BH providers to see cases with BH needs
• BH providers know which medical patients are likely in need of BH services through the
BH dashboard

25. Warm Hand Off Assessment
• Designed as short 30 minute assessment
• Immediate issues: safety, IPV, SI/HI, SUD
• Current BH care providers
• Appropriateness for/interest in Outpatient LOC
• Appropriateness for/Interest in Integrated BH
• Provisional Care Plan: refer back to medical,
refer to CHC BH, refer out to community
provider

26. BH Workflow: Initial Assessment
• Psychosocial Assessment
• Diagnostic evaluation
• Treatment Plan
• Disposition:
– Appropriate for care: individual, family, group
– Refer for psychiatric consult
– Refer to higher level of care

27. BH Workflow: Ongoing Treatment
• Sessions occur per care plan and are
documented in notes
• Consults with medical are recorded as TEs
• Care plan reviews documented as
required by state regulations, Joint
Commission standards, insurance
requirements

28. Group therapy offers additional services to patients who may have common
needs. While those common needs can be things like depression or trauma,
often identified in behavioral health care, but they might also be problems
commonly identified in medical visits.
• Smoking cessation
• Chronic pain
• Suboxone groups as a part of integrated Medication Assisted
Treatment
• Mood Disorders
• Trauma
BH Workflow: Group Therapy
All of these and more can create referrals for in
house services and serve to better integrated care
between medical and behavioral health.

29. Integrated Care Meetings
• A case review meeting conducted at each site facilitated by a BHCC
– Patients are selected from a risk stratified list and have chronic disease as
well as a BH condition.
• Goal of the meeting is to close care gaps and to reduce preventable ER
utilization
• Participants include the PCP, MA, RN, BH Clinician, and ATC
• Seven to ten cases are discussed per session
• Cases are presented by team members who have reviewed the record
respective to their role
• Documentation in the health record is completed. (Global Alert)
– Recommendations for follow up is noted in
TE’s or Action items.

30. Discharge from BH Care
• When care plan goals met: medical handback
• When higher level of care/specialty service needed
• When patient no longer attends sessions
– Recall system
– Outreach as required by state licensure
– Closing of BH case while leaving medical open
• Notification of PCP
• Transfer of meds to PCP or outside psychiatric provider
• Completion of discharge paperwork
• Patient may return to care within one year with same BH provider;
greater than one year requires new intake

31. Integration Occurs at Every Level
• Shared electronic health record: one
problem list, one medication list, full
access across disciplines to all notes and
documents
• IM and informal conversations in pods
• Flows bi-directionally
• Integrated care meetings

32. Shared Communication Among the Team

34. Questions

35. Visit our National Learning Library
Contact us at nca@chc1.com
www.chc1.com/nca

36. Resource Highlights
National Learning Library
www.chc1.com/nca
December 13th, 2018 | 3 p.m. EST: Behavioral Health Workforce
Development; Training Across the Various Behavioral Health Disciplines.
Video Slides
February 15 | 3:00 PM EST : Taking Team-Based Care to the Next Level.
Video Slides
February 22 | 3:00 PM EST : Advancing the Practice of RNs and Behavioral
Health Providers.
Video Slides

37. Blasi PR, Cromp D, McDonald S, Hsu C, Coleman K, Flinter M, Wagner E. Approaches to
Behavioral Health Integration at High Performing Primary Care Practices. J Am Board Fam
Med. Sept-Oct 2018: 31(5): 691-701.
Flinter M and Bamrick K, Ed. Kathleen Thies. Training the Next Generation: Residency and
Fellowship Programs for Nurse Practitioners in Community Health Centers. Middletown,
CT: Community Health Center, Inc. and The Weitzman Institute; 2017 Dec. Available
at: https://www.weitzmaninstitute.org/npresidencybook
References