Integrated Behavioral Health Care: Considerations for Clinical
Practice Methods & Offerings
Jeremy Bidwell, Ph.D.Theresa M. Schultz, Ph.D.
November 6th, 2014IPA Convention ~ Skokie, Illinois 1
2
“Integrated”
Care can be:◦ Integrated and co-located◦ Co-located, but not integrated◦ Separately located and integrated◦ Reverse co-located!◦ Coordinated on a spectrum, allowing for a range of comfort levels.
Receiving referrals and sending occasional updates represents the norm, and the bare minimum standard of care.
We can do a lot more!
Doing so this year is a great idea to give your practice a deep keel for the waters ahead.
3
4 Shifts in Practice Methods
Our goal: Give you some tangible ideas to take home and consider applying to your work next week.
4
Practice Shift #1
Stronger collaboration with Primary Care will foster growth
and resilience
Whatever your stage of collaboration, there are areas for all of us to develop
further.
5
Why should you work harder on collaboration? Approximately 68% with a diagnosable
mental health condition will seek treatment from their PCP, compared to the 28% willing to seek services from a Psychologist (Miranda et al., 1994).
32% of healthy individuals say they would seek out mental health treatment from their PCP if it were needed. Only 4% of those people stated they would approach a Psychologist. (National Mental Health Association).
(As cited in Gunn & Blount, 2009)
6
Primary Care Physician
Mental Health Specialist
Self-Referred to PCP
20%
Upwards of 80% of PCP patients with a MH issue may be inaccessible to you unless you change the way you work with medical providers.
7
Practice Shift #2
Communicating about failed referrals makes our entire
profession appear more reliable.
8
Referral Feedback The low number of follow-throughs on
referrals from PCPs gives the impression that we often don’t follow-up after a referral.
PCPs are used to 100% feedback on specialty medical referrals.
Physicians frequently complain that mental health is a “black hole”…they refer patients for MH services, but then never hear back from us.
9
How Do You Manage Referrals? The only way to achieve 100% feedback with 20%
follow-through is to be aware of every referral made.
Consider developing a system with your trusted referral sources that allows you to do this.
Give them access to your system, or gain access to their system, and then communicate.
Everything I have learned, for free: www.EarlyByrd.com
10
Practice Shift #3
Nothing competes with face-to-face contact!
If you don’t co-locate at all, consider shared case consultation
meetings.
11
Integration is a Spectrum
Close coordination Drop-in consults Shared staff meetings / Case discussions Minimal co-location (1/2 day) Part-time co-location Reverse co-location Embedded at multiple sites Fully embedded BHC provider
12
Practice Shift #4
Get consent, but do not be afraid to communicate with other “covered
entities” about patient care.
We have entered a new era of HIPAA communication (that started last
year).
13
A Few Thoughts on HIPAA You should develop all of the compliance protocols
described in the security rule under HIPAA, and maintain a “fire drill” manual. This is true of state confidentiality laws as well.
You should also keep in mind that the recent changes in the law were intended to be a “shot across the bow” of large healthcare organizations with negligent practices (according to the Deputy Director of HHS).
Use common sense, get permission, and focus on what is in your patient’s best interest. Do not be afraid to communicate, ESPECIALLY when your patient would like you to do so.
14
Example of a HIPAA Policy: Use of electronic devices with access to
Private Health Information (PHI):◦ All devices must be password-protected◦ All must have the capability to be located remotely
and erased remotely if lost (iCloud, Lookout)◦ Passwords to online accounts must be changed if a
device is lost, and an immediate report made to the HIPAA officer
◦ All patient-related documents must be encrypted◦ Encrypted cloud storage must have a Business
Associates Agreement (BAA) Sookasa, Microsoft, and/or Google will sign a BAA
Become well-versed in Integrated Behavioral Care◦ Self-study◦ Graduate Program-based study*◦ Illinois Psychological Association (IPA) Resources
Health Care Reimbursement Committee Health Care Reform Sub-Committee IPA-sponsored educational and professional workshops
Local* &/or national** professional training opportunities
Establish relationships with MH & Medical Colleagues◦ Integrated Behavioral Care◦ Traditional Medical Settings◦ Traditional MH Care Settings
Establish relationships with non-MH & non-Medical Colleagues
Link with BCM Resources
16
Take a Good Look at…Available Resources & Relationships
Inventory of Client/Patient Base◦ Presenting Concerns◦ Estimated impact on daily functioning◦ Intersections with physical health issues◦ Unmet needs – Frequent requests for services
“Routine” Prevention & Wellness Offerings◦ Psycho-educational information◦ Self-Help work or “Homework”◦ Group-based services◦ Links with outside resources
17
Take a Good Look at…What You Already Know
MH Colleagues◦ Specialties◦ Services
Medical & Other Health Care Colleagues◦ Referral Needs◦ Educational/Consultative Needs
Non-MH & Non-Medical Colleagues◦ Educators◦ Legal Advocates◦ Family Law Firms◦ Ministry Services◦ Private Agencies (serving individuals across the life span)
◦ Not-for-Profit Organizations◦ Entrepreneurial Groups
18
Take a Good Look at…Who You Already Know
Community Events◦ Health Fairs◦ Informational Presentations and Handouts for
Children, Parents, Families, Couples, Older Adults
Informal & Formal Educational Opportunities◦ Dr. Susan Myket’s “Lunch & Learn” sessions◦ “Log on for Life” (e.g., TMS “Healthy Aging” series)◦ Formal CE Presentations
Resource Identification & Linkages Illinois Tourette Resource Network (Shari Meserve, MS)
19
SHARE What You Know…Collaborate Creatively & Courageously
Seek out Colleagues in Need Consider the “Abundance Model”
◦ How can you help colleagues?◦ How can your colleagues help you?
Resource Sharing – How Can You Enhance Each Other’s Work?◦ Staff◦ Materials (e.g., Testing)◦ Space◦ Skill Sets
Co-Sponsor Events (for professionals & patients)
20
Ask for What You Need…Collaborate Creatively & Courageously
Seek out PCPs to refer patients to you who have medical diagnoses that require behavioral care. Examples: ◦ Type II Diabetes◦ High Cholesterol◦ Hypertension (HTN)◦ Obesity◦ Sleep Disturbances◦ Addictions
Educate your non-mental-health colleagues about the breadth and depth of your services and skills:◦ Traditional MH services◦ Non-traditional areas for MH services (e.g., behavioral management of
chronic health problems)
Bridge the Mental Health Provider-Primary Care Provider
Gap
21
Offer to work in tandem with PCPs and other healthcare providers (e.g., Nutritionists, PTs, OTs, S/LPs, Personal
Trainers) to support behavioral change and wellness
Offer prevention and wellness educational workshops for PCPs and other medical professionals (including medical residents/students)◦ Brown Bag Lunches◦ CMEs
Offer group formats to deliver behavioral care services (e.g., as supported by empirical evidence for addictions work)
22
Bridge the Gap: Create Connections
UMASS Certificate in Primary Care & Behavioral Health(http://umassmed.edu/CIPC/Training/Certificate-Programs/pcbh/Overview/)
36 hours of CEs (~$1,800 for training; can negotiate lower rate for group)
Primary Care Culture, Behavioral Health Needs & Working with Physicians
Evidence-based Therapies and Substance Abuse in Primary Care
Child Development and Collaborative Pediatric Practice
Integrating Care for People with Serious and Persistent Mental Illness Behavioral Health Care for Chronic Illnesses, Care Management & An Overview
of Psychotropic Medication in Primary Care
Behavioral Medicine Interventions: Health Behavior Change & Relaxation Response Techniques
Families and Culture in Primary Care; Advice on Implementation
23
Get Certified in Integrated Behavioral Care
Acquire brief (15-20 minutes) consult skills for use in primary care settings
Develop e-health & tele-health skills
Learn culture & language of primary care
See Hunter, C.L., Goodie, J.L., Oordt, M.S. & Dobmeyer, A.C. (2009) Integrated Behavioral Health in Primary Care. Washington D.C.: American Psychological Association.
See Cummings, N.A. & O’Donohue, W.T. (2011) Understanding the Behavioral Healthcare Crisis. New York: Routledge.
24
Expand Consultation Skills…
Why Group Therapy?Changing chronic habits often works better in groups:
Group members identify with others who have successfully made changes
Individual accountability to group
More cost-efficient treatment approach
Allows a higher hourly fee for Behavioral Care Specialists (Mental Health Providers or MHPrs)
25
Clinical Skill-Building:Develop Group Therapy Skills
o Areas of Specific Need:
Addictions Anxiety Cardiac Illness High Cholesterol Depression Type II Diabetes Hypertension Marital Problems Panic Disorder Chronic Pain Sleep Disorders Smoking Cessation Weight Loss
o Areas of Clinical Expertise:
• Acceptance & Commitment Therapy (ACT)
• Coaching of PCPs• Cognitive Behavioral Therapy
(CBT)• Couples Therapy• Dialectical Behavioral Therapy
(DBT)• Mindfulness Training• Motivational Interviewing• Pain Management• Relaxation Training• Stress Management• Wellness/Exercise
26
What to Consider:Develop Additional Consult & Clinical
Skills
Learn about web optimization & use it!◦ Enhance content on your website:
Descriptive content (i.e., not just bullet points) for: Every clinical service area Each population served by practice Profile of each clinical staff member and areas of clinical
expertise Practice Blog for postings by Clinical & Administrative Staff Electronic Newsletter (for practice-specific and broader
professional news) Links to community resources, journal articles, websites,
etc.
Establish a secure directory and immediate scheduling options via EarlyByrd
27
Develop Internet Resources
Integrate Integrated Behavioral Care:◦ Theory & Clinical Courses
Prevention and Wellness Medical Conditions w/ Behavioral Care
Components
◦ Clinical Training Opportunities Multi-Disciplinary Treatment Medical Settings (e.g., w/ co-located MH
services)
28
What Graduate Programs Can Do To Prepare…
BCM, LLC has the knowledge and resources to help you prepare to be a Provider/Behavioral Care Specialist in Integrated Behavioral Care
Contact us at our BCM Website for assistance: www.BehavioralCM.com
Or…
www.behavioralcaremanagement.com
Review our video on YouTube: www.youtube.com/watch?v=OVAOHmpQUqM
Consider joining us as a Member and/or Provider
29
How Can BCM Help You?
Contact us! Please!
We are both trained in Integrated Behavioral Health Care.
We are both committed to Health Care Reform efforts for our profession.
We are both a part of BCM, LLC efforts to support our profession.
Jeremy Bidwell, Ph.D. – Meridian Behavioral Health3923 Mercy DriveMcHenry, IL 60050 815-344-5061 (Fax: 5072)www.meridianbehavioralhealth.com
Theresa M. Schultz, Ph.D. & Associates15 Spinning Wheel Road, Suite 426Hinsdale, IL 60521630-323-3050 (Fax: 3058)www.tmspsychologicalservices.com
30
How Can WE Help You?