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 M INNESOTA C OLLABORATIVE P SYCHIATRIC C ONSULTATION S ERVICE L. Read Sulik, MD, FAACAP Senior Vice President – Behavioral Health Services Sanford Health.

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Presentation on theme: " M INNESOTA C OLLABORATIVE P SYCHIATRIC C ONSULTATION S ERVICE L. Read Sulik, MD, FAACAP Senior Vice President – Behavioral Health Services Sanford Health."— Presentation transcript:

1  M INNESOTA C OLLABORATIVE P SYCHIATRIC C ONSULTATION S ERVICE L. Read Sulik, MD, FAACAP Senior Vice President – Behavioral Health Services Sanford Health Clinical Associate Professor Department of Psychiatry, University of Minnesota Clinical Associate Professor Department of Clinical Neuroscience, University of North Dakota

2 Background  Minnesota background efforts  Minnesota 2006 Legislation  Minnesota 2010 Legislation to fund statewide psychiatric consultation service  Drug threshold workgroup  Minnesota Psychiatric Consultation Workgroup  Children’s Psychiatric Consultation Protocols workgroup  ADHD subgroup  Bipolar subgroup  Differential diagnosis, including trauma, anxiety disorders and disruptive behaviors subgroup  Eating disorder subgroup  Substance abuse subgroup  Triage subgroup 2

3 What is M h INT? Mental Health Integration & Transformation Program  A partnership w/ Minnesota healthcare organizations and additional support partners:  Healthcare Systems: Mayo Clinic, Sanford Health, Prairie Care, Essentia (5 th partner TBD)  Non-profits: Minnesota Psychiatric Information and Outreach (MPIO), REACH Institute  Project Management Consultant  Videoconferencing Vendor 3

4 What is the Purpose/Intent of the Minnesota Collaborative Psychiatric Consultation Service?  To increase quality and access to children’s mental health services across the state of Minnesota by…  Increasing primary care providers’ (PCPs’) skills and willingness to manage children and adolescents with mild-moderate mental health problems  Creating linkages and partnerships between primary care and specialty mental health providers  Increasing rapid access for selected face-to-face consultations  Reducing problematic prescribing practices via case-specific support and consultation  Building partnerships among Medicaid, private insurers, healthcare organizations, and providers to facilitate sustainability 4

5 Why is the Service Needed?  Traditional CMEs, written guidelines, and “hit-and-run” workshops and lectures are generally ineffective.  Evidence-based prescriber training methods need to focus on skills (not factual knowledge), and must address obstacles encountered in practice.  Effective training programs must use collaborative learning partnerships, vs. “one-down” relationships, and use PCP role models as co-teachers, similar to those being trained. 5

6 How Will the Service Achieve Its Purposes?  Targeted outreach to providers;  Systematic and regular communications to providers about available services and training opportunities;  Linkage assistance to available services;  Hands-on coaching, skills training, and information support;  Same-day phone consultation services (both voluntary and mandatory consultations); and  Rapid face-to-face evaluations for “emergent” cases. 6

7 M h INT Innovative Approaches  Web-based tool that allows providers to identify and link families to community resources;  State-of-art video-teleconferencing available at no cost to internet-linked healthcare providers state-wide;  “Pathway” to sustainability, with Medicaid codes approved for use by healthcare providers;  Creation of primary care “champions” who can in effect increase the state’s mental health manpower 7

8 Mayo Clinic subcontracts to M h INT Partner sites and other subcontractors Project Steering Group L. Vukelich & Associates REACH Soltrite MPIO Executive CommitteeSE Minnesota Region Mayo Clinic Western Region Sanford Health Northeastern Region Essentia Health Twin Cities - East Prairie Care Twin Cities - West TBA (e.g., Allina Health) M h INT Project Organization 8

9 Regional Teams 5 regional healthcare system teams, located strategically across the state Each team consists of: >2 Child/adolescent Psychiatrists (CAPs) >1 Triage Mental Health Professional (TMHPs) Other support staff as needed Multiple team members enable cross-coverage within and across sites 9

10 Leadership/Planning and Timetables Weekly EC Meetings Co-Chairs: 1 Site Principal, Linda Vukelich Partnership with by-laws guiding the collaboration Subcommittees and Assigned Tasks: Database, Website, REACH adaptations, Electronic Communications, CAP/TMHP Training, PR/Outreach, Program Evaluation Start-up phase June/July August 1 – December 31, 2012, 3-4 sites only January 1, 2013, and beyond: 5 sites 10

11 Web-Based Tools M h INT (via MPIO) will support the creation of a web-based tool that allows providers to identify and link families to available community mental health resources Regularly updated by M h INT Team & MPIO Publicly available 11

12 REACH Training  Hands-on, with role plays and extensive practice  2 days of face-to-face training with 15-30 clinicians, with 2-3 trainers, followed by:  6-12 months of twice-monthly phone call consultation and support, 1-1.5 hours/call  Individual case presentations, with learning and risk-taking shared among peers  6 years in development, used in NYS, Nebraska, North Carolina 12

13 HD Video Conferencing over the Internet Secure – HIPAA compliant PC, Mac, iPad, iPhone & Android Can interoperate with traditional video conferencing technology 13

14 Video conferencing Services Will likely include: Training Collaboration between and within MhINT partners and DHS Communication between primary care doctors and specialty mental health providers Potentially some patient consultations 14

15  Consultation Services

16 M h INT will not encourage PCP management of the following: 1. Psychosis 2. Suicidality beyond minimal risk 3. Aggression involving serious injury to others or serious destruction of property 4. Clear Bipolar I disorder 5. Substance abuse/dependence 16

17 Work Flow for Phone Consultations  Triage mental health professional (TMHP) takes the initial phone call and responds to calls within their scope of training and expertise.  If a child and adolescent psychiatrist (CAP) is needed/requested, the covering CAP returns the phone call at scheduled time (same day). 17

18  HIPAA I Voluntary phone calls are consultations to the primary care provider (PCP), as well as a clinical service to patients. PCPs will maintain records of the consultation, and ensure patient confidentiality and HIPAA-compliance. Protected health information (PHI) NOT needed for voluntary consults. De-identified demographic and clinical information can be used to provide evaluation of the project.

19  Face-to-Face Consultations

20  Selected cases will be seen for a face-to-face (or possibly, telepsychiatric if the patient is geographically distant) consultation with a M h INT child/adolescent psychiatrist.  Face-to-face (FTF) evaluations will be scheduled within 1-2 weeks with the local child/adolescent psychiatrist. 20

21 Face to Face Evaluations are Consultations Only  Face to face evaluations are consultations only, with follow-up as needed by PCPs.  Patients cannot be followed by CAPs for ongoing treatment and medication management.  PCPs will need to apprise patients and families about this. 21

22 Resources & Contact Info  DHS Website : _DYNAMIC_CONVERSION&RevisionSelectionMethod= LatestReleased&dDocName=dhs16_158267 _DYNAMIC_CONVERSION&RevisionSelectionMethod= LatestReleased&dDocName=dhs16_158267  L. Read Sulik, MD, FAACAP  Senior Vice President – Behavioral Health Services, Sanford Health  Email:  Telephone: 701 234 4124 22

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