Minnesota Collaborative Psychiatric Consultation Service

1. Minnesota Collaborative Psychiatric Consultation Service L. Read Sulik, MD, FAACAP Senior Vice President – Behavioral Health Services Sanford Health read.sulik@sanfordhealth.org 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

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

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

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.

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.

7. MhINT 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

8. MhINTProject Organization Mayo Clinic subcontracts to MhINT Partner sites and other subcontractors

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

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

11. Web-Based Tools • MhINT (via MPIO) will support the creation ofa web-based tool that allows providers to identify and link families to available community mental health resources • Regularly updated by MhINT Team & MPIO • Publicly available

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

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

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

15. Consultation Services

16. MhINT will not encourage PCP management of the following: • Psychosis • Suicidalitybeyond minimal risk • Aggression involving serious injury to others or serious destruction of property • Clear Bipolar I disorder • Substance abuse/dependence

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).

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. Face-to-Face Consultations • Selected cases will be seen for a face-to-face (or possibly, telepsychiatricif the patient is geographically distant) consultation with a MhINTchild/adolescent psychiatrist. • Face-to-face (FTF) evaluations will be scheduled within 1-2 weeks with the local child/adolescent psychiatrist.

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.

22. Resources & Contact Info • DHS Website: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_158267 • L. Read Sulik, MD, FAACAP • Senior Vice President – Behavioral Health Services, Sanford Health • Email: read.sulik@sanfordhealth.org • Telephone: 701 234 4124