Behavioral Health and Conference... · 2011-05-14 · Integrating Behavioral Health and Preventive...
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Integrating Behavioral Health and Preventive Care within Preventive Care within Patient‐Aligned Care Teams: Michael G. Goldstein, MD and Margaret Dundon, PhD VHA National Center for Health Promotion and Disease Prevention Andrew Pomerantz, MD and Edward Post, MD Primary Care‐Mental Health Integration, Office of Mental Health Services
Transcript of Behavioral Health and Conference... · 2011-05-14 · Integrating Behavioral Health and Preventive...
Integrating Behavioral Health and Preventive Care withinPreventive Care within Patient‐Aligned Care Teams:
Michael G. Goldstein, MD and Margaret Dundon, PhD
VHA National Center for Health Promotion and Disease Prevention
Andrew Pomerantz, MD and Edward Post, MD
Primary Care‐Mental Health Integration, Office of Mental Health Services
Pillars of the Medical Home•The primary care team is focused on the whole person•Patient‐preferences guide the care provided to the patientPatientPatient‐‐DrivenDrivenPatientPatient‐‐DrivenDriven
•Primary care is delivered by an interdisciplinary team led by a primary care provider using facilitative leadership skillsTeamTeam‐‐BasedBasedTeamTeam‐‐BasedBased
•Patients receive the care they need at the time they need it f d l f h h hEfficientEfficientEfficientEfficient from an interdisciplinary team functioning at the highest level of their competency
EfficientEfficientEfficientEfficient
•Primary care is point of first contact for a range of medical, behavioral and psychosocial needs, fully integrated with ComprehensiveComprehensiveComprehensiveComprehensiveother health services and community resources
ComprehensiveComprehensiveComprehensiveComprehensive
•Every patient has an established and continuous relationship with a personal primary care providerContinuousContinuousContinuousContinuous
•The communication between the patient and other team members is honest, respectful, reliable, and culturally sensitive. “Patient Centered Communication”
CommunicationCommunicationCommunicationCommunication
•The PCMH team coordinates care for the patient across and between the health care system including the private sector.CoordinatedCoordinatedCoordinatedCoordinated
Veteran-CenterednessWhole Whole Person Person
Environment/ Environment/ Physical PlantPhysical Plant
CollaborativeCollaborative
OrientationOrientationPhysical Plant Physical Plant
Outcomes Outcomes ––MeasurementMeasurementCollaborative Collaborative
Partnership Partnership MeasurementMeasurement
Veteran Veteran CenterednessCenterednessEff tiEff ti
Multimodal Multimodal CenterednessCenterednessEffective Effective CommunicationCommunication
Access to Access to CareCare
Patient Aligned Care TeamPatient Aligned Care TeamPatient Aligned Care TeamPatient Aligned Care Team
Access Practice Care M t & RedesignManagement & Coordination
Patient Centeredness: Mindset and ToolsPatient Centeredness: Mindset and Tools
Improvement: Systems Redesign VA TAMMCSImprovement: Systems Redesign VA TAMMCSImprovement: Systems Redesign, VA TAMMCSImprovement: Systems Redesign, VA TAMMCS
Resources: Technology, Staff, Space, CommunityResources: Technology, Staff, Space, Community
Other Team
Other Team MembersClinical Pharmacy Specialist: ± 3 panelsClinical Pharmacy anticoagulation: ± 5 panelsSocial Work: ± 2 panels
For each parent facilityHPDP Program Manager: 1 FTE 1 FTE Health Behavior Coordinator: 1 FTE1 FTEMembers
Social Work: ± 2 panelsNutrition: ± 5 panelsCase ManagersTraineesIntegrated Behavioral Health
Psychologist ± 3 panelsSocial Worker ± 5 panels
Health Behavior Coordinator: 1 FTE1 FTEMy HealtheVet Coordinator: 1 FTE 1 FTE
Teamlet: assigned to 1 panel (±1200 patients)
Provider 1 FTE1 FTE
Social Worker ± 5 panelsCare Manager ± 5 panelsPsychiatrist ± 10 panels
Panel size Panel size adjusted adjusted
• Provider: 1 FTE1 FTE• RN Care Mgr: 1 FTE1 FTE• Clinical Associate (LPN MA or
Monitored via Monitored via Primary Care Primary Care
Staffing and Room Staffing and Room Utilization DataUtilization Data
(modeled) for (modeled) for rooms and rooms and staffing per staffing per PCMMPCMM(LPN, MA, or
Health Tech): 1 FTE1 FTE• Clerk: 1 FTE1 FTE
Utilization DataUtilization Datareport in VSSCreport in VSSC
PCMM PCMM Handbook Handbook
Patient
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Behavioral Health Providers in the PACT M d lPACT Model
Population‐Based Care:P i• Prevention
• Early identificationA d t• Access and acute care
• Effective chronic disease management • Brief evidence based treatments• Brief, evidence based treatments• Engagement and adherence/follow‐through• Clinical and functional outcomes• Clinical and functional outcomes• Consultation
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Vision of VHA Preventive Care Programg
• The Veteran will experience health promotion and d h l ldisease prevention interventions that are seamlessly integrated across the continuum of their health care and are delivered in a variety of modalitiesmatchedand are delivered in a variety of modalities matched to the Veteran’s needs and preferences
• VHA clinicians and clinical support staff will value andVHA clinicians and clinical support staff will value and participate in the delivery of interventions for patients as appropriate to each Veteran’s priorities and overall plan of care
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Preventive Care Program
Core Elements:• Infrastructure – New Staff
• Health Behavior Coordinators
• Health Promotion Disease Prevention Program Managers
I t ti ith PACT• Integration with PACT• Tools and Resources
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Healthy Living MessagesHealthy Living Messages Eat wisely.
Be physically active.
Maintain a healthy weight.
B t b f Be tobacco free.
Limit alcohol.
Get recommended screening tests Get recommended screening tests
and immunizations.
Manage stress.g
Be safe.
Get involved in your healthcare.
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Tools and Resources• Clinical Staff Guide for Healthy Living Messages
M H lth Ch i• My Health Choices
• Clinical Staff Guide for Health Coaching
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Health Behavior Coordinator Roles:Facility Level Activities
• Established Roles ‐ Collaborates to develop and improve clinical
Facility Level Activities
programs and services:– Contributes to Veteran‐centered “culture change”
– Contributes to medical home redesignContributes to medical home redesign
– Monitors performance of key metrics
• Opportunities for Expansion:– Integrate Health Risk Appraisal resource into care and self‐management
– Integrate additional telephone‐based and eHealth interventions into care
– Develop/test new strategies for tailoring/combining interventionsp/ g g/ g
– Develops new metrics
– Conducts effectiveness/implementation research
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Health Behavior Coordinator Roles: Trainer/Coach/Guide for PACT Staff
• Established Roles ‐ Leads and coordinates training and coaching of P i C t ff i
Trainer/Coach/Guide for PACT Staff
Primary Care staff in:– Health coaching, motivational interviewing, self‐management support
strategies
• Opportunities for Expansion:– Deepen and extend training/coaching role – “force multiplier”
– Assessment of clinical staff competency/performance (e g directAssessment of clinical staff competency/performance (e.g., direct observation, simulation center, patient experience measures
– Spread training/coaching to other clinical services (e.g., specialty care, geriatric care mental health)geriatric care, mental health)
– Spread training/coaching to peer & community‐based interventionists
– Research regarding training/coaching roles and outcomes
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Health Behavior Coordinator Roles: Direct Clinical ServicesDirect Clinical Services
• Established Roles ‐ Provides direct clinical services to Veterans:Tobacco cessation treatments (with Tobacco Cessation Lead Clinicians)– Tobacco cessation treatments (with Tobacco Cessation Lead Clinicians)
– Weight management groups (with MOVE! staff)
– Bariatric surgery assessment
– Wellness clinics
– Self‐management groups for Veterans with chronic conditions
• Opportunities for Expansion:Opportunities for Expansion:– Extend existing program with alternative modalities (e.g. telegroups,
online hosting)
Sleep problems/Insomnia groups– Sleep problems/Insomnia groups
– Pain management groups
– Problem‐solving/Stress‐management
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Behavioral Health Issues in Primary Care
M di lMedical Conditions
MentalHealth Mental Health
ConditionsRisk
Behaviors ConditionsBehaviors
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Models of Primary Care-Mental Health/Behavioral Health IntegrationMental Health/Behavioral Health Integration
ColocatedCollaborative IntegratedClinics Model
CollaborativeModel
Integrated Care
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R fReferences
• Rollnick, S., Butler, C. & Miller, W. (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press.
• Miller WR, Rose, GR (2009). Toward a Theory of MotivationalMiller WR, Rose, GR (2009). Toward a Theory of Motivational Interviewing. Am Psychol. September ; 64(6): 527–537.
• Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., & Mash, B. (2010). Competent Novice: Motivational Interviewing. British Medical Journal, 340(7758) 1242‐1245340(7758), 1242 1245.
• Robinson, P. & Reiter, J. (2007) Behavioral consultation and primary care: A guide to integrating services. New York: Springer Science‐Media.
• Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated Behavioral Health in Primary Care: Step by step Guidance forIntegrated Behavioral Health in Primary Care: Step‐by‐step Guidance for Assessment and Intervention, American Psychological Association.
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