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. INTEGRATED BEHAVIORAL HEALTH IN NEWAYGO COUNTY – FLYING THE PLANE AS WE BUILD IT Dr. Mark Kuiper, MD Sarah Bowman, LMSW
- 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. 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. 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. Prior to IBH in Newaygo County….
- 6. Now……
- 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. 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. Our Flight Manual IBH Clinical Protocol Referral Process Patient flow Quadrant Model Documentation
- 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. Newaygo County Mental Health Primary Care Provider Consultation Note Name: 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 Asthma Plan: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _______________________________________ _________________ Clinician Signature Date _____________________________________ _________________ Primary Care Provider Signature Date
- 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. 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. 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. 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. “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. “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. 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. 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. Questions?
- 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