Transcript Integrated Primary Behavioral Health Care: An ongoing

Primary Care and Behavioral
Health Integration within the Free
Clinic Setting: Developing a
PCBH Model of Care
Alysia Hoover-Thompson
[email protected]
Radford University
Presented at the Mental Health Roundtable
Virginia Health Care Foundation, Richmond, VA
August 16, 2011
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Radford University Psy.D. Program
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First cohort began providing services to
community in 2008 as part of training program
 Students provide mental health services to local
community organizations
 Many of these organizations are not-for-profit
 Program emphases
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Rural practice
Cultural diversity
Social justice
Evidence-based practice
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Free Clinics
 “Free
clinics are volunteer-based, safetynet health care organizations that provide
a range of medical, dental, pharmacy,
and/or behavioral health services to
economically disadvantaged individuals
who are predominately uninsured”
(National Association of Free Clinics, 2008)
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Free Clinic of the New River Valley
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On site
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Who Qualifies?
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Medical
Dental
Pharmacy
Dermatology clinic
Adults without health insurance
“Low income” based on 2010 Federal Poverty
Guidelines
Mental Health Association of the New River
Valley
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Provides pro-bono counseling services to MHA clients
at an office located in the Free Clinic
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Why Integrated Care?
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Up to 70% of visits to primary care offices are
related to behavioral health needs
 Many common medical problems that are
treated by PCP involve health and behavioral
habits that influence symptoms (Hunter, Goodie,
Oordt, & Dobmeyer, 2009)
 In 2008, the American Psychological Association
launched the Primary Care Initiative
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Developing an Integrated
PCBH Site
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Psy.D. Program Director approached by Free
Clinic Director
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Program students had previous experience providing
traditional mental health services at site through
Mental Health Association
Joshua Bradley was the first Psy.D. student from
Radford to complete a practicum there
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Developed forms and documents for integration
Developed comprehensive 360 degree evaluation
procedure to assess integration into the system and
performance
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Integrating PCBH Services into an
Established System
 Emphasize
that you are there to support
existing services
 Try to accept as many referrals as
possible in order to show usefulness
 Get to know all people in the clinic
 Explain what you do
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Have a prepared explanation and examples
Create a handout
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Systemic Contextual
Considerations
 Names
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and Faces
Virginia College of Osteopathic Medicine
residents
On site physician
Nurse practitioners
Nurses
Front office staff
Volunteers
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Patient Contextual Considerations
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Given the low-income client base, there may be relevant
considerations related to intervention options
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Clients may lack financial resources to make significant changes
to their diet or join a gym
Transportation may be a problem
High frequency of significant financial and environmental
stressors
Literacy rates may be lower
Other contextual factors will undoubtedly become apparent as
the BHC becomes more familiar with the client base
This speaks to the importance of being aware of cultural
and contextual factors when working within an integrated
care system
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Primary Care Environment
 Fast
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paced
Adjust clinical note taking
 Space
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limitations
At least 7 different rooms
Move from room to room frequently
 Finding
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Several places they can be
 New
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medical charts
faces
Remembering names
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Patient Referrals
 Self-Referred
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Request to see Mental Health Counselor at
appointment with physician/NP
 Physician/NP
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Request for BH evaluation/intervention
 Warm
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Referred
Hand-off
Occurs in exam room
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Additional Activities
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Consultation with medical staff
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Presentations to clinic staff
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Example: Patient is in abusive relationship and
medical resident asks about treatment options. BHC
explains options such as Women’s Resource Center,
Mental Health Association, etc… Medical resident
presents options to patient
Safety in medical settings
Behaviors that increase appointment/treatment
adherence
Case management
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The First Year
 201
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Total Contacts
21 warm hand-offs
54 referrals
126 follow-up appointments
 111
Cancellations/No Shows
 Primary Complaints
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Depression (64), Anxiety (44),
Diet/Exercise (38), Relationship problems (32)
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The Second Year
 Two
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students and two days/week
Mondays, Wednesdays and Fridays at the
Free Clinic in Christiansburg
Wednesdays at Giles satellite office
 Want
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to increase warm hand-offs
Will increase number of patients seen
 Utilize
360 evaluation
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Adjusting to Environment
 “Client”
versus “patient”
 Transportable office
 Medical terminology
 Brief encounters (as short as 5 minutes)
 Case management
 Educator/Presenter
 In-house mental health representative
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Conclusion
 Different
paradigm
 Multiple treatment setting considerations
 Need to be flexible
 Fit into system
 Requires more directness and behavioral
focus because of time limitations
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