Establishing an Integrated Behavioral Health Program and Practicum Site in a Community-Based Primary Care Center Christina S. Lee, Ph.D. Dept. of Applied Psychology Northeastern University, Boston, MA IBH Program Director South End Community Health Center, Boston, MA
Co-located 2
Integration Primary Care Dan Simpson, M.D. Tom Sterne, M.D. Deb Clifford, R.N. Behavioral Health Laurie Goldman, Psy.D., R.N. Ray Walden, L.I.C.S.W. Alexander Young, Psy.D. Rick Silva, Pharm.D. Interns: Heather Bennett Atsushi Matsumoto
March, 2013 April 20, 2013 Integrated Behavioral Health (IBH) Program planning begins. Proposal for the IBH Program and Psych Intern training submitted by Dr. Lee to the SECHC. IBH Intern training objective is to pilot IBH training curricula for SECHC psychology interns. Timeline Year 1 May, 2013 The curriculum for the IBH Program and the IBH Seminar series is developed. July 1, 2013 Focus group moderated by Dr. Lee with providers (n=15; 4 Adult medicine, 2 Family medicine, 2 Pediatrics, 6 Ob/Gyn, 1 Hass Center) on perceptions of behavioral health before IBH. Suggestions used to improve awareness, training needs, and communication regarding the IBH Program and intern training. IBH Planning July 15, 2013 IBH Program meeting with interdisciplinary providers and IBH interns Discussed IBH referral process between provider and consultant, triage process of linking out to care Sept 6, 2013 First IBH intern class orientation at SECHC. Sept 10, 2013 Sept 19, 2013 Introduction of IBH program to SECHC clinicians. The Roll-Out presentation. The purpose of IBH and referral process is presented. Survey and focus group findings presented. IBH Seminar Series begins and IBH interns begin shadowing providers IBH intern seminars Oct 1, 2013 IBH begins seeing patients Nov 17, 2013 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns Dec 12, 2013 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns
Jan 25, 2014 March 3, 2014 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns. Providers give positive feedback on IBH. Discussion on how to improve referral system, and advantage of inperson referral IBH referral process reviewed by Admin team. Preliminary IBH data reviewed. New patient screening tools discussed Timeline Year 1, cont. IBH coordination and Intern seminars June 3, 2014 IBH manual drafted August 4, 2014 Procedures to gather IBH patient satisfaction survey reviewed. Focus group with providers planned.
Integrated Health Seminars 2013-2014 1. Functional Assessments and the 5As 2. Integrated behavioral health: Anxiety and depression 3. Medical literacy 4. Writing case notes for integrated care 5. Substance use assessments 6. Crisis management 7. Adult psychopharmacology in mental health, Part I 8. Negotiating behavior change in health behaviors 9. Adult psychopharmacology in mental health Part II
Integrated Behavioral Health Coverage Schedule November 2013 Location: SECHC PAATHS Office 2 nd Flr IBH Consultant Contact Number: 857-301-0154 Common Reasons for Referral: Stress, Insomnia, Anxiety/Fears, Chronic Pain, Mild Depression, Headache, Anger, Relationship Problems, Grief or Bereavement, Low Back Pain, Diet (weight loss, dietary adherence problems), Tobacco Use, Exercise, Chronic Illness Management: Diabetes, GI Problems, COPD, Medication Adherence Services: Consultation (30 minutes) for assessment and behavioral health treatment planning, recommendations, and interventions Purpose: To help patients develop practical knowledge and skills to promote and improve physical and emotional health Contact Procedure: Intern provides primary coverage - CONTACT FIRST. Staff provides back-up coverage when necessary Referral Procedure: Complete IBH Referral Form found in EMR under Letters tab, and (when possible) flag IBH consultant on call. Introduce patient to IBH consultant and provide IBH consultant with any relevant patient information General Hours of IBH Coverage: 9:00-12:00 (AM) and 1:00 4:00 (PM) Monday: AM INTERN- Heather Bennett CONTACT: 857-301-0154 STAFF- Richy Villa CONTACT: ext. 7671 PM INTERN- Heather Bennett CONTACT: 857-301-0154 STAFF- Richy Villa CONTACT: ext. 7671 *Indicates individual is Spanish speaking Mental Health Interpreter Services are available for non-spanish speaking consultants
IBH Referral Form Date: Patient Name: DOB: Preferred Language: [ ] English [ ] Spanish [ ] Other: Referring Provider: Referral Type: [ ] Routine [ ] Urgent-seen in 2-3 days [ ] Emergent Reason for referral: [ ] Anxiety [ ] Grief [ ] Depression [ ] Recent Psych Hospitalization [ ] Smoking Cessation [ ] ADHD/ADD Evaluation [ ] Diagnostic Evaluation, e.g. Bipolar, ADD, other [ ] Substance Abuse [ ] Other: Referral to: [ ] Pharm D: For comprehensive medication management for anxiety, depression, other psychiatric conditions, access to Specialty BH 3 rd floor [ ] CAMI Study: Alcohol use disorders, substance use [ ] Integrated BH Consultant: For evaluation and short term counseling; e.g. anxiety, depression, relaxation training, grief, sleep hygiene, smoking cessation, substance use [ ] Specialty Behavioral Health Service 3 rd floor [ ] PLEASE CALL PATIENT: Patient could not see clinician today, but wished to be called Telephone number (confirmed with patient): NOTE: IBH will usually see patient up to 3 visits and will refer to Specialty Behavioral Health, 3 rd floor, if patient needs long term management.
Importance of in-person referral Referral Type Pts seen Remaining to be seen Total Paper 52 (36%) 93 145 Verbal 33 (89%) 4 37 Flag 2 1 3 Paper & Verbal 4 0 4 Total 91 98 189
Patient Satisfaction Survey* *Based on the Client Satisfaction Survey (citation) 1. How would you rate the ease of making an initial appointment with the Health and Wellness consultant? (1) Poor (2) Fair (3) Good (4) Excellent 2. How would you rate the ease of making a follow-up appointment with the Health and Wellness consultant? (1) Poor (2) Fair (3) Good (4) Excellent 3. Did you get the kind of help you wanted from the Health and Wellness consultant? (1) No, definitely not (2) No, not really (3) Yes, generally (4) yes definitely 4. How satisfied are you with the help you received from the Health and Wellness consultant? (1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied 5. If a friend were in need of similar help, would you recommend the health and wellness consultant to him or her? (1) No, definitely not (2) No, I don t think so (3) Yes, I think so (4) Yes, definitely 6. Has the help you received from the Health and Wellness consultant helped you to deal more effectively with your concerns? (1) No, seemed to make worse (2) No, didn t really help (3) No, didn t really help (4) Yes, a great deal 7. In an overall, general sense, how satisfied are you with the help you have received from the Health and Wellness consultant? (1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied 8. If you were to seek help again, would you come back to see a health and wellness consultant? (1) No, definitely not (2) No, I don t think so (3) Yes, I think so (4) Yes, definitely
Student education and training IBH Manual drafted Seminars planned Supervision issues and coverage Smaller cohort
Counseling PhD Student participation and development IBH Internship Track at SECHC 6 Phd Level trainees IBH researchers: Welcome to our new Northeastern Counseling Ph.D students. Check them out on our website! Janelle Alabiso, M.A. Daniel Gittens Stone, M.A.
Thank You to the South End Community Health Center, and to the Psychology Interns for making this work possible!
Christina S. Lee, Ph.D. Dept. of Applied Psychology Northeastern University, Boston, MA Chr.lee@neu.edu Www.Northeastern.edu/cslee