Transcript Collaborative and Integrated Care for Women Across the Life Span: Models,

Session #A1
October 28, 2011
10:30AM-12:00PM
Collaborative and Integrated Care for
Women Across the Life Span: Models,
Successes and Challenges
Dr. Mary Clare Champion
Dr. Helen Coons
Dr. Anne Dobmeyer
Dr. Sally Haskell
Dr. Susan McDaniel
Collaborative Family Healthcare Association 13th Annual Conference
October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Cherokee Health Systems
Faculty Disclosure
We have not had any relevant financial relationships
during the past 12 months.
Cherokee Health Systems
Need/Practice Gap & Supporting
Resources
Women are not only suffering from rising rates of
chronic illnesses, but they are the health care leaders
for their families. Improving care for women, both
their own health and in their health-related
education, will improve outcomes for entire families.
Cherokee Health Systems
Objectives
• Identify how health care has an opportunity to
improve the health of women through providing
comprehensive collaborative care.
• Describe a collaborative model of care that
incorporates behavioral health into primary and
prenatal care.
• List particular benefits and challenges in utilizing this
model in regards to improving family health.
Cherokee Health Systems
Expected Outcome
• An appreciation for having an integrated focus and
how this could impact the health of women.
• Strategizing in how to integrate behavioral services
within practices bridging between patients receiving
primary and prenatal care.
• Increased consideration of how to implement
practices that will allow for early identification and
intervention of challenges for women.
Cherokee Health Systems
Integrated Care Defined
“Integrated Care is a concept bringing
together inputs, delivery, management
and organization of services related to
diagnosis, treatment, care, rehabilitation
and health promotion. Integration is a
means to improve the services in
relation to access, quality, user
satisfaction and efficiency.”
-WHO European Office for Integrated Health Care
Services. Integrated Care. Working Definition. 2001
Cherokee Health Systems
Integrated Care Model
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Behavioral Health Consultant (BHC) member of
Primary Care team
PCP and BHC often see patient together
Integrated charts and treatment plan
BHC appointments are conducted in exam room
Open availability for BHC, 100% of time devoted to
integrated care
Brief, focused, evidence-based behavioral
interventions and follow-up
Cherokee Health Systems
Cherokee’s Primary Care
Clinical Model
● Embedded Behavioral Health Consultant on the
Primary Care Team
● Real time behavioral and psychiatric consultation
available to PCP
● Focused behavioral intervention in primary care
● Behavioral medicine scope of practice
● Encourage patient responsibility for healthful living
● A behaviorally enhanced Healthcare Home
Cherokee Health Systems
The BHC in Primary Care
• Management of psychosocial aspects of chronic and
acute diseases
• Application of behavioral principles to address
lifestyle and health risk issues
• Emphasis on prevention and self-help approaches,
partnering with patients in a treatment approach
that builds resiliency and encourages personal
responsibility for health
• Consultation and co-management in the treatment of
mental disorders and psychosocial issues
Cherokee Health Systems
Blending BHC into Primary
Care
• BHC is an embedded, full-time member of the
primary care team
• BHC provides brief, targeted, real-time interventions
to address the psychosocial aspects of primary
care
• Primary Care Provider determines that psychosocial
factors underlie the patient’s presenting
complaints or are adversely impacting the
response to treatment
Cherokee Health Systems
Integration in Context…
Full Integration
The Primary Care Team
• Shared/coordinated
responsibility of care
Patient
Physician
• Supports cultural
competency among staff
Behavioral
Health
Clinician
• To the patient it feels
like primary care.
• Charting in one
chart/one format
• Creates seamless
spectrum of care
Cherokee Health Systems
Why is it important to focus
on women in FQHCs?
• Rise in chronic health
concerns
– Diabetes, depression,
obesity
• Uninsured women least
likely to have had
provider visits in the
last year
• Uninsured women less
likely to have regular
screenings
• Uninsured women
report delaying or going
without care
• Women are health care
leaders for their families
– Coordinate care for
children
– Care for sick/elderly
relatives
Women and Health Care: A National
Profile; Key Findings from the Kaiser
Women’s Health Survey , Kaiser
Permanente (2004)
Cherokee Health Systems
Special Concerns for Women
• Chronic Health Concerns
– Cardiovascular disease
– diabetes
• Relationship Health
– Domestic violence awareness
• Reproductive Health
– Pregnancy care
– Education re: contraceptives
– Importance of routine preventative care
Cherokee Health Systems
Postpartum Depression
• Onset usually occurs within first 4
weeks of delivery
• Can appear within the first year after
delivery
• Prevalence rates vary from 20% to 5%
Cherokee Health Systems
Symptoms
Same as Major Depression
– Lack of interest in
activities
– Agitation/irritability
– Changes in sleep
– Changes in appetite
– Crying spells
– Feeling withdrawn or
isolated
– Poor energy
– Thoughts of death or
suicide
– Feelings of shame or
guilt
Cherokee Health Systems
“Baby Blues”
• Up to 80% of new mothers
• Symptoms can be present for a few
hours to a few days
• Symptoms are milder than a Major
Depressive Episode
• Symptoms go away on their own or
with help from support system
• Do not require medical intervention
Cherokee Health Systems
Postpartum Psychosis
• Much more severe
• Break with
reality/presence of
psychotic symptoms
• Immediate
treatment is
imperative
• Andrea Yates
– Houston mother
whose mental health
deteriorated after the
birth of each of her
five children. She
drowned all five of
them in 2001,
responding to
delusional material
telling her that her
children were at risk
Cherokee
Health Systems
of being
harmed.
Mothers at risk…
• Under age 20
• Unplanned/unwanted
pregnancies
• Behavioral health
history – self or
family
• Stress during
pregnancy
• Presence of previous
postpartum
depression
• Financial stressors
• Poor support
• History of child
abuse/neglect
• Substance abuse
history
• Relationship
concerns
Cherokee Health Systems
Diagnosis?
• Edinburgh Postnatal Depression Scale
– Available in English and Spanish, easy to
administer
– Can be given at mom’s postnatal follow-up
or at infant well-child visits
Also important to screen for other reasons
for symptoms (i.e., thyroid, substance
abuse)
Cherokee Health Systems
Awareness is key
• Vital to inform expectant mom and her
support system
• Many new moms ignore or won’t
discuss postpartum symptoms
• Psychoeducation can help reduce
stigma, encourage mother to report
concerns
Cherokee Health Systems
Enter the
Behavioral Health Consultant
• Behavioral Health Consultant (BHC) can
provide psychoeducation about
Postpartum Depression
– Part of routine care
– No stigma
– Possible during normal OB appointment or
during follow-up
Cherokee Health Systems
Other care
• Along with BHC, expectant mothers
can/are seen by
– Dentistry
– Nutrition
Cherokee Health Systems
Prevention
• Increased awareness – both for
expectant mom and for those around
her
• Improved self care
• Screening during pregnancy
• Reduced stigma = earlier report =
reduced incidence of more severe
symptoms
Cherokee Health Systems
Treatment options
• Early detection is key so treatment can
start as soon as possible
– Supportive therapy
• Individual/family/support groups/online support
– Psycho-education
– Psychopharmacology
Cherokee Health Systems
What if Mom isn’t
my patient?
• Still important to screen for postpartum
depression
• Can incorporate into pediatric well-child
visits
– Screen with Edinburgh, provider interview
– Provide psycho-education about symptoms,
prevention
– Start treatment if necessary
Cherokee Health Systems
Challenges
• Financial barriers
– Uninsured/underinsured
– Struggles with co-pays
• Patient resistance
– Push back when change is necessary
– Lack of family awareness/support
• Access to care
– Limited access to specialty referrals
Cherokee Health Systems
Learning Assessment
A learning assessment is required for CE credit.
Attention Presenters:
Please incorporate audience interaction through a
brief Question & Answer period during or at the
conclusion of your presentation.
This component MUST be done in lieu of a written
pre- or post-test based on your learning objectives to
satisfy accreditation requirements.
Cherokee Health Systems
Session Evaluation
Please complete and return the
evaluation form to the classroom
monitor before leaving this session.
Thank you!
Cherokee Health Systems