The Journey to Integrated Mental Health/Aging Systems of Care

1. The Journey to Integrated Mental Health/Aging Systems of Care Presented by Lee Fraser, MA, RNC, QMHP Recognized by the American Society on Aging and Pfizer Medical Humanities for Innovation and Quality in Healthcare – Awarded 2005 The University of Kentucky Sanders Brown Center on Aging 23rd Annual Summer Series on Aging June 12-14, 2006

2. Overview • By 2030 - the US population over 65 will increase from 13% to 20% (a 7% increase) • 1 in 5 community based seniors have at least one mental health diagnosis* • This figure will more than double by the year 2030* *Klap, et al, 2003 * Bartles, 2004

3. Scope of Problem • Less than ½ receive treatment* • Non-treatment increases risk of health complications, poor medical treatment response, mortality, caregiver burnout, and overburdened systems * Bartles, 2004

4. Promising Potential • Most psychiatric illnesses are 80% treatable in elders • Culture of care is in transformation • Model integration projects are available • Demonstrate positive outcomes • Can be replicated

5. Reasons for Integrated Care • National imperatives for collaboration • Outcomes research positive for outreach model and collaborative care* • Built in referral base *Bartles, 2004

6. Reasons for Integrated Care • Early detection, enhanced access, reduced health risk, shared cost potential, decreased caregiver burden • Mental health providers potential for increased knowledge of older adults and their services • Aging service providers gain mental health skills and resources

7. Reasons for Integrated Care • Benefits to Elders • Cohesive and informed care • Early intervention • Reduced stigma • Enhanced self-care potential • Prevention of premature institutionalization • Promotion of interdependence

8. Reasons for Integrated Care • Model programs obtain: • Outreach expansion • Multidisciplinary mix • Shared synergy – cost • Shared risk • Expanded service capacity for prevention, intervention, crisis, education, family care and access to resource

9. Retrospective on Systems of Care • Mental health treatment evolved from non-treatment to med treatment • Use of psychotropic medications(1950’s) • Major deinstitutionalization (1960’s) • Gero Psychiatry has approximately 60 years of history

10. Retrospective on Systems of Care • Aging services evolved in 30’s and 60’s • Mental health services once grant funded are now fee for service • Mental health programs for seniors highly vulnerable to fee for service

11. Promoting Innovation and Change • Build on history of successes • Identify community needs • Example: MHASI Survey Handout • Identify partners

12. Strategies for Change/Formation • Consider highest purpose and needs of all partners • Relationships are essential and critical to success • Consider universal needs first – then unique aspects • Learn the essential elements of each program • Get administrative buy-in

13. Strategies for Change/Formation • Start one small joint venture • Find and promote champion agencies for change • Find and build leaders • Use model programs as a template • Example: Featured Program Handout • Consider perceived threats of integration • Seek consultation

14. Strategies for Change/Formation • Rational versus Relational - models for change: • Rational model provides information and anticipates change • Relational model focuses on the theories of “diffusion” and “stages of change”

15. Strategies for Change/Formation • Communicate early and often • Coalitions, partnerships, collaborations, services, and entire systems are built on Relational models • Influence one key member of a group • Changes move in a linear fashion in the short term but move in concentric circles of broader influence with longer lasting impact

16. Strategies for Change/Formation • Diffusion Theory - means by which innovations are spread throughout a population, adopted over time • Change is a “social process” • Parallel Process - theory can be applied to whole systems as well as individuals

17. Three Principles of Innovation • Innovations are “anything” new to a group • Interpersonal influence peaks when rate of adoption is at a max • Adoption of innovation occurs in stages • Awareness, persuasion, initial action, full implementation, confirmation/reinforcement

18. Brainstorming • Model Program Elements (see handout) • Discussion • Short Break

19. Model Program – 3 Key Components • Systems Integration – the first step to growth of older adult programs • Affiliate at all levels – medical, education, policy, advocacy • Balance player mix • Consumer involvement • Revisit needs and scope • Provide a product – agree to be outcomes driven • Obtain TA/MIS support

20. Model Program – 3 Key Components • Direct Service/Consultation • Outreach 90% of Direct Service Base • Multidisciplinary staff mix – medical, social • Include board certified Gero Psychiatrist Medical Doctor • Use medical alternates – NP’s, PA’s • Extend outreach – telemed, consultation • University linkage – interns, research • Partner with F.Q.H.C. clinics

21. Model Program – 3 Key Components • Integrate with primary care medical groups • Peer-to-peer support groups • Include caregiver, prevention support • Use Aging CCU’s and Elder Abuse Units as referral base • Determine levels of client engagement • Integrate within mental health programs within comprehensive agencies

22. Model Program – 3 Key Components • Education and Training • Train everyone at all levels • Include prevention and recovery • Wellness • Normative aging • Most common diagnoses • Use of service system • Code mandates

23. Model Program – 3 Key Components • Education’s System Integration – Cross train on Best Practices Models • In-services (other providers) • Area wide conferences • State conferences • Web page, designated events/dates, fact sheets • Develop a manual and CD’s • Assure quality graphics, logos and program brochures

24. The Journey is Realized • Group Exercises

25. Chestnut Mission Statement • Making a difference: improving quality of life through excellence in service. Chestnut Vision Statement • Chestnut Health Systems will be a leader in the development and delivery of superior human services.