Community Mental Health Authority of Clinton, Eaton, Ingham Counties Care Integration Ashley Beard, LPC Community Mental Health Authority of Clinton, Eaton, Ingham Counties

Learning Objectives 1. Participants will be able to identify 3 benefits of collaboration between behavioral health and primary care. 2. Participants will be able to identify 2 ways to incorporate behavioral health into clinic work flow.

What is Integrated Health Care “Integrated health care is the systematic coordination of physical and behavioral health care. The idea is that physical and behavioral health problems occur at the same time. Integrating services to treat both will yield the best results and be the most acceptable and effective approach for those being served.” – The Hogg Foundation for Mental Health6

“Integrated primary care combines medical and behavioral health services to more fully address the spectrum of problems that patients bring to their primary medical care providers. It allows patients to feel that, for almost any problem, they have come to the right place.”– Alexander Blount, Ed.D., director, Center for Integrated Primary Care7 Embedding primary and behavioral care in one setting to achieve easier access to services and resources for families. Enhanced coordination, alignment, linkage, and relationships among care providers.

Research Data 80% of people with a behavioral health disorder will visit a primary care provider at least once a year 50% of all behavioral health disorders are treated in primary care 48% of appointments for all psychotropic agents are with a non-psychiatric primary care provider 70% of primary care visits are related to psychosocial issues 67% of people with a behavioral health disorder do not get behavioral health treatment 30-50% of patient referrals from primary care to an outpatient behavioral health clinic do not make the first appointment Two-thirds of primary care physicians report not being able to access outpatient behavioral health for their patients. Shortages of mental health care providers, health plan barriers, and lack of coverage or inadequate coverage were all cited by primary care providers as critical barriers to mental healthcare access Better physical and behavioral outcomes, improved quality and cost effectiveness of services and supports, more family-centered care, opportunities for early behavioral health intervention.

CEI’s Initiatives CMHA-CEI Integrated Care Initiative has worked to enhance the availability of mental health treatment services to patients of the various county Health Department clinics as well as primary care clinics within the Tri-County Area. The goal is to provide brief, evidence based, effective, outcome focused, services which are coordinated with primary care services in a fully integrated manner.

The program has expanded care among primary and behavioral health practioners, strengthening screening for behavioral health issues and follow-up therapy in local pediatric clinics of Sparrow Health System, Michigan State University, and the Ingham County Health Department.

History of MSU Child Health Patient Centered Medical Home Social Workers since 2009 MiPCT Workers MC3 Collaboration with CMHA-CEI, DHHS, and University of Michigan Embedded practice for me

Role of BHC Behavioral Health Consultant works as part of the primary care providers team to identify behavioral health issues as well as quickly responding to health behavior challenges. Interactions last between 10-30 minutes, unlike that of typical outpatient treatment. Interactions occur in tandem with primary care provider(warm hand off) visits or separate of provider. Appointments can be scheduled independently with the Behavioral Health Consultant.

Use of Screens “Mass screening in primary care could help clinicians identify missed cases and increase the proportion of depressed children and adolescents who initiate appropriate treatment. It could also help clinicians to identify cases earlier in the course of disease.” – U.S. Preventive Services Task Force4

Bright Futures/American Academy of Pediatrics Recommendations

MCHAT ASQ PSQ (Depression) SCARED (Anxiety) Additional Screens used as needed

Physicians' Views

Michigan Action Learning Network http://cfs.cbcs.usf.edu/projects-research/_docs/LANbrief1.pdf http://cfs.cbcs.usf.edu/projects-research/_docs/LANbrief2.pdf http://cfs.cbcs.usf.edu/projects-research/_docs/LANbrief3.pdf http://cfs.cbcs.usf.edu/projects-research/_docs/LANbrief4.pdf

1 American Academy of Pediatrics. (n. d. ). At issue 1 American Academy of Pediatrics. (n.d.). At issue. Retrieved from www.aap.org/mentalhealth. 2 Primary Care Perspectives on Care Integration for Children and Families. (2016, April). Michigan Action Learning Network on Primary & Behavioral Health Integration For Children & Families, 5. 3 National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, D.C.: The National Academies Press. Retrieved from http://books.nap.edu/openbook.php?record_id=12480. 4 Williams S.B., O’Connor, E., Eder M., & Whitlock E. (2009, April). Screening for child and adolescent depression in primary care settings: A systematic evidence review for the U.S. Preventive Services Task Force. Rockville, Maryland: Agency for Healthcare Research and Quality. Retrieved from www.uspreventiveservicestaskforce.org/uspstf09/depression/chdepres.pdf. 5 National Research Council and Institute of Medicine. (2009). Preventing mental, 6 The Hogg Foundation for Mental Health. (2008, December). Connecting body and mind: A resource guide to integrated health care in Texas and the United States. Retrieved from www.hogg.utexas.edu/uploads/documents/IHC_Resource_Guide1.pdf. 7 Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions. Fisher, Lawrence; Dickinson, W. Perry American Psychologist, Vol 69(4), May-Jun 2014, 355-363. http://dx.doi.org/10.1037/a0036101