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Bridging the gap

Bridging the gap. Rachael Bowers, LICSW Nandini Sengupta , MD April 3, 2013. Why Integrate???. Barriers to Access Behavioral Health Services Financial Concerns July 2011: Launch Behavioral Health Pediatric Integrated Program (BHPIP)

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Bridging the gap

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  1. Bridging the gap Rachael Bowers, LICSW NandiniSengupta, MD April 3, 2013

  2. Why Integrate??? • Barriers to Access Behavioral Health Services • Financial Concerns • July 2011: Launch Behavioral Health Pediatric Integrated Program (BHPIP) • January 2012: Complete integration of all Pediatric BH Services into BHPIP

  3. Our Model – Who We Are

  4. Our Model – What We Do • Individual and Family Therapy • Psychiatry (weekly) • School-Based Behavioral Health Services • Consultation to PCPs during medical appointments

  5. Our Model – How We Do It • Strong Clinic Leadership Commitment to Integrate • Co-location • Warm Hand Off • Pediatric Social Worker • Shared EMR • Shared Administrative Staff • Primary Care Behavioral Health Consultation Training • Creative Access to Child Psychiatry Services

  6. Co-Location Fall 2013: Rate of referral = 16/month CONSTRUCTION BHPIP Moves across the hall at the end of November Rate of referral DROPS to 8.5/month Seasonal Variation? Not entirely: Winter 2012 ROR 13/month

  7. Warm Hand-off • Tracking began July 1, 2013

  8. Warm Hand-off CONSTRUCTION • July - November 2013: WH rate 53% • December 2013 – February 2014: WH rate 21%

  9. Bridging the gap

  10. Outcomes I - Access • Referrals to BH at Dimock increased from 18% to 63% • Wait time for Services reduced to 1-2 weeks • Why refer to other agencies? • 1. Language Needs • 2. Preference for School Based Services at a School Dimock does not serve • 3. Preference for Home-Based Services • 4. Distance

  11. Outcomes II - Quality of Care • COMPLIANCE WITH INTAKE: 67% • Rough estimate of compliance pre-integration: ~30%

  12. Outcomes III – Financial Sustainability • Cost Neutral by the end of second Fiscal Year • More streamlined/efficient use of Employee Time

  13. Outcomes IV - Morale • 1.Mutual Respect of Providers’ Disciplines • 2. Frequency and Quality of Communication • Leading to better understanding of patients (both MD and BH) and better compliance and tracking of patients within BH services • 3. Improved Access to Services and Access to Informationabout Treatment (for MD) • 4. Role of SW to facilitatethe process from both MD and BH perspectives • 5. Feeling of support and efficacy in role (BH)

  14. Expansion OBHI (Ob/Gyn and Behavioral Health Integration) Launched November 1, 2013 Funded by Children’s Hospital • Introduction of BH services at New OB appointment • MH Screening at prenatal and post-partum appointments • Access to BHPIP for services when needed or requested

  15. Where Next? Behavioral Health Consultations • 1. Increase: Could we reach more than 7% of Pedi patients? • 2. Billing???

  16. Where Next? Could we integrate care of chronic conditions?

  17. Where next? How do we redefine the “closed” BH case?

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