2. Introduction Physical-mental health integration is an evidence-based approach that supports collaboration between physical health and behavioral health providers to improve the identification and triage of those in need of mental health services.

3. General Info… Promotes the collaboration between primary care providers and behavioral health specialists Various models of how to integrate services being implemented nationwide, i.e. IMPACT model, Gatekeeper model, etc. 8 demonstration projects with NYS Office of Mental Health to deliver physical-mental health integrated services to older adults – South Oaks is grantee

4. Why Integrate? Individuals/families that are closely connected with a PCP have a trusting relationship with that doctor Individuals/families are more likely to follow up with appointments either in their PCP’s familiar location or coordinated by their PCP rather than traveling to a new doctor or initiating an appointment on their own Better communication among all parties, screenings for early intervention and treatment, better health and family outcomes, lower healthcare costs

5. Our Experience South Oaks Hospital successfully participated in an integration demonstration project with the NYS Office of Mental Health. Now working to establish integrated relationships between behavioral health specialists and pediatricians/family practitioners. Recent grantee of the NYSHF for this purpose.

6. First Step Develop Collaborative Relationships with area PCP’s (takes time and effort AND listening!) What does their patient caseload look like? How many people does the PCP see daily? Does the PCP have BH experience? Are they comfortable identifying those in need? What is the insurance mix of his/her patient load? How will the office staff be involved in the planning? Etc……

7. Next Steps Define the collaborative agreement with the PCP (Shared space? Lease agreement? etc.) Identify Local BH Resources (What is currently available?) Discuss Screening Tools (PHQ2 or 9, other heath screenings) Develop Practice Specific Protocols Screening completed during office visit? Who will review it? Who will refer patient for services? Where will services take place? How will the services be billed?

8. Next Steps continued… Establish plan to share records electronically Plan communication protocols for ongoing dialogue How and when will cases get reviewed? How will treatment plan be updated and whose input will be included? How will progress be monitored/measured? How will crisis/emergencies be handled? Plan for use of other communication technology

9. Monitor Outcomes Design how to measure health outcomes, i.e. reduced symptoms, better patient engagement, fewer ER visits Design how to measure “life” outcomes, i.e. living independently, socializing, improved school outcomes, relationship development, etc. Utilize EMR to communicate and measure progress Conduct satisfaction surveys

10. Some Lessons Learned….. Fear and a lack of understanding between PCPs and BH Providers often paralyzes forward movement when considering collaboration PCP’s are the primary source of basic mental health treatment, particularly in areas where access is limited PCP’s struggle with the many psychosocial needs of their patients and the needs of their families Older adult-specific issues Youth-specific issues Family situation-specific issues Screening/Assessment opens the door to a myriad of psychosocial issues which cannot be ignored Case management needs: adequate housing or in home support, safety, nutrition, social isolation, health insurance, medications, managing chronic conditions, etc.

11. Lessons Learned continued… Collaboration does work! Symptoms improve! Providers offer more comprehensive treatment to their patients! People get healthier!

12. Future Framework Establishing PCP and BH collaboration at the start of a practice Seeing integrated model as routine Routine screening and prevention Wellness mindset PCPs developing trusting relationship with Psychiatrist peers Telepsychiatry Consultation, i.e. Project TEACH Reimbursement Models for Sustainability Utilizing appropriate billing codes Accountable care Bundled payments

13. Examples of Success Harvard Vanguard Medical Associates Kaiser Permanente Blue Cross/Blue Shield of Rhode Island Vermont/Massachusetts

14. Questions

15. Contact Information: The Long Island Home: d/b/a South Oaks Hospital Dr. Kristie Golden kgolden@south-oaks.org