The Integrated Behavioral Health Service Tiffany Cummings, M.S., Natasha Mroczek, M.S., & Thom Harrell, Ph.D. School of Psychology Florida Institute of Technology

Objectives of the Presentation Explain the Integrated Behavioral Health Service Model and how if differs from traditional/specialty Mental Health care Clarify the scope of service of the Behavioral Health Consultant Describe the benefits of integrating Behavioral Health Consultants (BHCs) with primary care medical providers

What is an Integrated Behavioral Health Service? Service provided by a psychologist, who is working as a Behavioral Health Consultant (BHC) to the patient and to the medical care team Patients are seen for health behavior change and health management as well as psychiatric symptoms BHCs are available immediately during working hours, so they are able to see patients same day in most cases Patients are typically seen for minutes on initial referral Initial contact includes assessment and initial treatment recommendations to patient, and feedback to physician Follow-up contacts are typically minutes, and can be linked to medical visits Most patients are seen for 3-5 visits. When more extensive intervention is required, patients are referred to traditional mental health services

Reasons for Referrals Chronic Medical Conditions  Diabetes, hyperlipidemia, hypertension, cancer, chronic pain, RA, IBS, fibromyalgia, etc. Physical problems with a behavioral component  Obesity, insomnia, chronic headaches, etc. Prevention  Smoking cessation, diet/exercise change Difficult patient interactions/behaviors  High resource users, disruptive patients, patients who are noncompliant with medical treatment

Reasons for Referral Psychiatric Disorders  Mood Disorders, Anxiety, Personality Disorders, Psychoses Substance Use Disorders ETOH, Narcotics Sub-threshold Conditions  Bereavement, relationship problems impacting health, stress, domestic violence/abuse Suicidal concerns

 Childhood obesity  Chronic somatic complaints  Behavior problems ADHD Social skills training Parenting skills training Reasons for Pediatric Referrals

 Only 20% of all patients referred to external mental health providers complete the referral  67% of all psychotrophic medications are now prescribed by primary care physicians  80% of all antidepressant medications are now prescribed by primary care physicians  Chronic medical conditions are the fastest growing area of primary care, but 60% of all patients with chronic conditions do not fully adhere to medical recommendations Why integrate behavioral health and primary care?

Consultation model is designed to respond to the physician’s specific referral question or concern Behavioral Health Consultant role is brief and focused, as opposed to traditional mental health provider service delivery Behavioral Health Consultant is available to physicians and patients (on referral) for immediate consultation Behavioral Health Service Concepts

Physician may briefly consult with BHC prior to referral, or simply have nurse check on BHC availability. Physician notes referral and reason for referral in patient’s medical chart. BHC will see patient immediately if available or later the same day if wait is not too long. Otherwise an appointment with the BHC will be scheduled. BHC completes a contact note in patient’s chart and gives verbal feedback to physician if requested. BHC will coordinate immediately with physician to address any emergency situations. Referral Process

Explaining Referral to the Patient Sample Introduction Scripts: Example 1: It sounds like you might be having a lot of stress right now. I work with someone who specializes in helping with these issues, and I would like you to speak with them today to better help me help you. Is it alright with you if I introduce you to her/him? Example 2: It’s really important that you better manage your weight. I have a colleague who can give you some specific ideas about how to do this. Her/His office is just down the hall. My nurse will walk you there after we’re done. It’s best not to use the terms therapist, counselor, or psychologist when referring. We use the title Behavioral Health Consultant because it doesn’t have any stigma or connotations.

 Immediate, prn consultation to physicians on any patient-related matter  Brief assessment of patients with findings and treatment plan documented in patient’s medical chart  Patient education / written plans and guidelines for change / handouts  Home-based patient practice or engagement in new behavior Coordinate intervention with case management as needed Behavioral Health Service Intervention Overview

Physician notified of status via contact notes in patient’s chart BHC may provide planned booster sessions for at-risk patients via 3- month clinic appointments or telephone appts. Termination & Follow-Up

Advanced Clinical Psychology Doctoral Students serve as primary on-site Behavioral Health Consultants. A FL Licensed Clinical Psychologist serves as clinical supervisor. Supervisor is available to students at all times they are in the clinic via phone. We will conduct an ongoing evaluation of service delivery and outcomes, and we encourage your feedback at any point in time. Florida Tech BHC Program Implementation