Degree of Integration

Transcription

1 Integrated Primary Care and Behavioral Health Services at Community Clinics and Health Centers: RESULTS OF THE 2012 BEHAVIORAL HEALTH SERVICES ADVOCACY AND NETWORKING SURVEY FACT SHEET: Integrated Behavioral Health Degree of Integration Respondents report a high degree of integration between physical and mental health services, but less so with substance abuse services. The vast majority have integrated treatment team meetings or trainings. COMMUNICATION: The majority of Community Clinic and Health Center (CCHC) respondents have either moderate (41%) or high (41%) levels of communication between primary care and behavioral health (BH) staff including or shared electronic health records. CO-LOCATED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES: More than half (60%) of CCHCs have primary care provider (PCP) services that are co-located with mental health (MH) services in the same practice area. Some (18%) have the services in the same building but in different practice areas. There is little consistency for CCHCs in the physical proximity between primary care and substance use treatment services. Almost one-third have very low proximity (30%) in that they are separated by a distance greater than four blocks. Twenty-three percent (23%) of CCHCs offering these services have very high proximity where substance abuse services is provided in the same practice area as primary care, and 10% have high proximity in that they are located in the same building but in different practice areas. BEHAVIORAL HEALTH SERVICES AND EXPERTISE: Almost all responding CCHCs have high (58%) or very high (28%) levels of BH services and expertise available within the primary care setting. High is defined as basic BH expertise available with a licensed counselor onsite for face-to-face consultation and treatment, all pharmacological services provided onsite with counseling services as needed, and only complex BH problems referred off-site for specialty care. Results of the 2012 Behavioral Health Services Advocacy and Networking Survey 1

2 Very high is defined as a wide range of specialty BH services available within the clinic setting. There is minimal need to refer patients off-site for BH services. STIGMA With regard to eliminating the stigma associated with patients accessing mental health services: 24% of respondents reported that staff always avoid treating BH as if it was a separate program for those in need of BH services; 32% made minimal distinction in terms of signage or clinic names; 24% made some attempt to avoid referring to it as a separate program but had separate signage such as Integrated Care Office or Collaborative Care Office. 16% had signage like Behavioral Services or Health Counseling, and staff made little attempt to avoid referring to it as a separate program; 5% of CCHCs viewed the BH office as a separate setting for those needing specialty assistance, like Mental Health Office or Psychiatry Service. INTEGRATED TREATMENT TEAM MEETINGS OR TRAININGS The vast majority of responding clinics (79%) have treatment team meetings or trainings that include PCPs and BH providers. The meeting format ranges from clinical staff daily team huddles to review patients to be seen that day, to monthly interdisciplinary team meetings, to quarterly meetings to promote collaborative care and resolve procedural issues. Some clinics offer quarterly, semi-annual, or annual trainings with both primary care and behavioral health staff on common concerns, such as medication management. Generally speaking, clinics would like to encourage team meetings or trainings, but these are expensive endeavors as it means pulling providers away from patient care, thereby reducing productivity and clinic income. Responding clinics indicated they have the following types of treatment team meetings or trainings: Daily team huddles including a PCP and BH Monthly meetings between PCPs and BH provider providers regarding chronic pain patients Weekly provider meeting including Monthly medication therapy management psychiatrists and PCPs meetings Weekly provider meetings to discuss the Quarterly meetings offered as CME to behavioral health workflow providers Weekly HIV Team meetings including the Quality assurance sessions consisting of a MD, LCSW, and BH counselor PCP and a licensed psychologist at a Weekly or monthly case management minimum meetings Routine attendance of the integrated care Bimonthly meetings on integrated care and coordinator at provider meetings in the training PCPs on psychotropic medications Adult and Women's Health Center; semi- attended by mental health and medical regular meetings of the department heads providers and the care coordinator. Results of the 2012 Behavioral Health Services Advocacy and Networking Survey 2

3 We have weekly multi-disciplinary treatment team meetings at each clinic, which includes primary care and behavioral health staff, and sometimes MAs and other ancillary staff. The purpose of the meetings is to review cases, coordinate care and focus on furthering integration goals/quality improvement measures. We have twice annual trainings with both primary care and behavioral health medical staff present. The purpose is to receive more information about difficult diagnostic presentations (pain management; inquiring about substance abuse). We also have biweekly staff meetings with the psychiatrist, PCP's and mental health therapist. Four times a year we have a nonmedical provider training for behavioral health and CCHC staff on the same topics as the integrated medical provider meeting. CLINIC STORY: INTEGRATED PHYSICAL AND BEHAVIORAL HEALTH SERVICES An MFT at a federally qualified health center in Sacramento, The Effort, has been instrumental in helping Joe, a 39-yr-old with Medi-Cal. Joe was under the care of a psychiatrist for treatment of cooccurring disorders of bipolar disorder with a history of suicide ideation, substance abuse, and alcohol dependence. Joe mentioned he was having problems in his relationship, and that those problems triggered severe depression and substance abuse. His psychiatrist suggested he meet with the clinic MFT. The MFT worked with Joe individually as well as jointly with his partner to help them improve communication, decrease arguments, manage stress, and develop a plan to support Joe in his sobriety. Because Joe signed a release of information, the MFT was able to share the treatment plan with the psychiatrist, so the psychiatrist could be aware of the work Joe and the MFT did together in support of his mental health and substance use. When Joe also mentioned he had chronic back pain, the MFT referred him to a clinic physician to help him to manage it without using narcotics. Prior to the medical appointment, the MFT shared the patient s history of substance abuse and the patient s treatment plan with the physician as well. As a result of the care he received, Joe reports improved mood and improved physical health. Results of the 2012 Behavioral Health Services Advocacy and Networking Survey 3

4 Patient-Centered Health Home Over three-quarters of health centers (77%) are seeking patient-centered health home recognition, and many of those have included a behavioral health provider as part of their care team. STATUS OF HEALTH HOME RECOGNITION Of those seeking patient-centered health home recognition, 53% have received or are seeking recognition from the National Committee for Quality Assurance, 22% from The Joint Commission, and 3% from the Agency for the Accreditation of Ambulatory Health Centers. Half (50%) of those seeking PCHH recognition have organized their providers into care teams (i.e. a physician, nurse, medical assistant, and/or a health educator). Of these, 57% include a behavioral health provider, such as an LCSW, clinical psychologist, LMFT or case manager, as a member of the care team. WHAT IS A PATIENT-CENTERED MEDICAL [OR HEALTH] HOME? A patient-centered medical [or health] home is a model of care that strengthens the physicianpatient relationship by replacing episodic care with coordinated care and a long-term healing relationship. Each patient has an ongoing relationship with a personal physician who leads a team at a single location that takes collective responsibility for patient care, providing for the patient s health care needs and arranging for appropriate care with other qualified clinicians. The medical home is intended to result in more personalized, coordinated, effective and efficient care. A medical home achieves these goals through a high level of accessibility, providing excellent communication among patients, physicians and staff and taking full advantage of the latest information technology to prescribe, communicate, track test results, obtain clinical support information, and monitor performance. Source: NCQA Patient-Centered Medical Home Brochure We are in the process of assessing reorganization into teams and defining what care teams will look like for purposes of PCHH. Behavioral health staff will definitely be included in teams at each of our primary care sites. Results of the 2012 Behavioral Health Services Advocacy and Networking Survey 4

5 Integrated Medical Records Among respondents that have implemented E.H.R., primary care and behavioral health providers are able to easily view each other s notes and treatment plans, and add to a common problem list, which was not usually the case with paper medical records. As of May 2012, 87% of CCHCs had either implemented E.H.R. or had purchased their E.H.R. system and were scheduled to begin implementation. About 22% were scheduled to implement a system and 3% were in the purchasing process. Only 10% were still evaluating E.H.R. products. RESPONDING CCHCS PURCHASED THE FOLLOWING E.H.R. PRODUCTS: 46% NextGen 18% eclinicalworks 5% Centricity 3% Allscripts 28% Other (i.e., Epic, Med 3000, e-mds, IC-Chart, Exym in the mental health department, Welligent and Avatar) FOR RESPONDING CCHCS THAT HAVE IMPLEMENTED E.H.R.: Three-quarters of respondents (78%) have a section or tab for behavioral health services. Almost all (90%) have systems in which their primary care and behavioral health providers can mutually view each other s complete note in the E.H.R. without blocks or firewalls. AMONG ALL RESPONDING CCHCS, WHETHER THEY USE E.H.R. OR A PAPER MEDICAL RECORD: 76% allow behavioral health providers to add to the problem list. 56% contain shared patient self-management goals that the medical and behavioral health provider can easily view. 42% share a common integrated treatment plan that each can easily view. In May 2012, the California Primary Care Association s Behavioral Health Network surveyed community clinics and health centers (CCHCs) about the broad scope of behavioral health services provided to their patients. A series of fact sheets such as this one were developed to summarize the results. Staff from 40 CCHCs, the majority of whom were the behavioral health directors, responded to the survey. One survey was completed per health center even if they had multiple sites. Of the respondents, 88% were FQHCs and 10% were lookalikes. Fact sheets can be found on the CPCA website at (Rev ) Results of the 2012 Behavioral Health Services Advocacy and Networking Survey 5