Social Work Practice in Primary Care: A Natural Collaboration

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Bryce George
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1 Social Work Practice in Primary Care: A Natural Collaboration Presented by: Center for Social Work in Healthcare University of Oklahoma

2 Examine the fit between Patient Centered Medical Home (PCMH) and Social Work practice Explore models for use of social work and behavioral health integration in the PCMH Review the types of interventions and services commonly provided by the social worker in the PCMH Discuss the experiences of various settings thus far Convey opportunities and challenges to social work in PCMH Topics Covered

interventions and services commonly provided by the social worker in the PCMH Discuss the

healthcare arena, with an emphasis on primary care.

3 Central Focus Education Research and evaluation Technical assistance Support to practices Two Basic Goals Increase and improve the educational experience of social work students in preparation for work in the healthcare arena, with an emphasis on primary care. Expand and support the use of social work within primary care and other strategic outpatient medical services Center for Social Work in Healthcare Anne and Henry Zarrow School of Social Work

4 Changing Expectations for Primary Care The Patient Centered Medical Home (PCMH)

5 Costs escalating Quality/continuity of care variable (good for some-poor for many) Few receiving preventive and screening services Evolution of complex system

6 The PCMH was first articulated/developed by the Academy of Pediatrics The Family Practitioners shortly thereafter launched their version They are very similar in philosophy and basic tenants Now widely adopted and promoted SoonerCare Affordable Care Act Many others A New/Old Model (Re)Emerges

very similar in philosophy and basic tenants Now widely adopted and

7 Each person has a personal PCP The personal PCP leads a team of healthcare professionals who collectively provide the care There is a WHOLE PERSON orientation The care is patient centered The Basic Tenants of a PCMH

provide the care There is a WHOLE PERSON orientation

8 A whole person orientation Focus on empowerment and self determination Ability to use multiple lenses: Person inenvironment Appreciate the interlocking nature of internal and external issues that impact Health and well-being Social Work values, orientation and skills are a match for primary care

interlocking nature of internal and external issues that impact Health

9 Social Workers are the broad-scoped generalists of the mental health disciplines Core Biopsychosocial approach Case management skill and training Resource knowledge and development Social Work values, orientation and skills are a match for primary care

management skill and training Resource knowledge and

10 Increased expectations for screening Depression Substance use Tobacco Developmental delay And more Estimations that 70% of the people who come in for primary care have a problem with roots in behavioral concerns However the Stress and Expectations are High for practices.

people who come in for primary care have a problem with roots in

Historically health and mental health were two systems of care with very little intersecting or coordination All current science regarding

11 Historically health and mental health were two systems of care with very little intersecting or coordination All current science regarding the brain and body point to the need to re-organize our care systems into a one holistic care system The Reunification of two systems of care

regarding the brain and body point to the need to re-organize our

12 In some studies, half of the population being served in primary care complain of depression/anxiety Of the people with depression/anxiety in a PCP office, over 90% say they would prefer to speak with someone there instead of be referred for counseling Early evaluations of the collaborative care and specifically the BHCM are very favorable Why Provide Integrated Care?

would prefer to speak with someone there instead of be referred for counseling Early

13 Providing primary care services within community mental health systems Establishing a mental health unit within an outpatient care clinic Consultation and referral agreements Integration models There are several models in use

an outpatient care clinic Consultation and referral

14 Behavioral Health consultant (usually social worker or psychologist) sees patients/clients alongside/right before or after PCP Visits with SW are usually minutes with some as long as 30 Often uses a warm hand-off between PCP and SW Shared record-no separate or additional notes/paperwork Behavioral Consultation Model in Primary Care

15-20 minutes with some as long as 30 Often uses a warm hand-off between PCP and SW

15 Patient Education Behavioral Activation Relaxation/stress reduction General coping strategies Supportive listening Cognitive Techniques Problem solving/goal setting Social Work practice/skill set also a match for patient needs

Supportive listening Cognitive Techniques Problem

16 Cognitive-behavioral therapy Motivational Interviewing Psychoeducation Acceptance and Commitment Therapy Therapeutic Approaches

17 Improving screening processes for mental illnesses, substance abuse disorders, suicide, sleep disturbance, etc. Improving referral processes to outside mental health and substance abuse services Improve access to and coordination of behavioral care Social Work role in improving patient care processes

Improving referral processes to outside mental health and substance abuse

An introduction to the warm hand-off (6:08) http://www.youtube.com/watch?v=umif1tddkrm A newly diagnosed case of depression with anxiety (5:53) http://www.youtube.com/watch?v=ps5vjaxusbe A type II diabetic case (3:58) http://www.

18 An introduction to the warm hand-off (6:08) A newly diagnosed case of depression with anxiety (5:53) A type II diabetic case (3:58) A newly diagnosed bi-polar patient (6:32) A weight control case (5:51) Pain management and quality of life (5:53 Case study of an alcoholic patient (8:47) Insomnia (4:16) Videos

youtube.com/watch?v=duvg0o0e6ps Pain management and quality of life (5:53 http://www.youtube.com/watch?v=9kphdv7m6pw Case study of an alcoholic patient (8:47) http://www.

19 Recruitment and selection Coordination of schedules and space Education of staff regarding the role and services of the social worker Education of patients regarding the service Finding What Works

20 Warm handoffs vs. scheduled appointments Targeting specific symptoms/diagnoses Documentation in electronic medical record Finding What Works

21 Reimbursement for appropriate provision of mental health services Increase screening reimbursement Potential for reimbursement through Health and Behavior codes Increased physician billing SoonerCare PCMH Tier increase Supporting the position

The Field of Counseling. Veterans Administration one of the most honorable places to practice counseling is with the

The Field of Counseling. Veterans Administration one of the most honorable places to practice counseling is with the Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration