Connecting Primary Care and Specialty Mental Health: Moving from Competition to Collaboration

1. Connecting Primary Care and Specialty Mental Health:Moving from Competition to Collaboration Cynthia Cartwright, MT RN MSEd Melissa Cormier, LCSW Mary Jean Mork, LCSW October 11, 2013 CFHA Session G1b

2. …Or, acknowledging our different lenses and planning to bring it all into a shared focus.

3. Workshop Outline Description of present culture rift (10 min) Identification of potential strategies to reduce rift at all levels (10 min) Activity (10 min) Planning for your next steps (10 min)

4. Learning Objectives: Attendees will be able to: Identify the cultural and organizational differences that influence the present mistrust between health care providers and mental healthcare providers Develop strategies to target and reduce the culture rift at all levels: from leadership to the individual practitioners

5. Who are we?

6. Maine - Where we live and work.

7. On a bad day…. …connection between primary care and mental health looks like….

8. On a good day… …connection looks like…

9. What do you need to look at differently?

10. Connecting at all levels Leadership Practice/Program People

11. Leadership Challenges Financial – history of “carve-out’s” and separate budgets Different rules and regulations Competing priorities Turf

12. Leadership Strategies Look for linkages – e.g. ACO development, Health Homes Foster champions and change agents Maximize connecting opportunities - locally and regionally Support emerging leaders Communicate respectfully and often Appreciate competing demands, but also where linkage becomes important Build relationships

13. Practice Level Culture Clash

14. Mental Health & Primary Care Differences

17. What did we learn? • There’s concern about time to talk • No emphasis on meeting in person • Desire by both to have a “working relationship” • Communication is key • Patients/clients are not a barrier

18. Practice/Program Strategies Set up targets for improved access Clarify expectations and aim for timely communication Set up regular meetings Promote the use of standardized screening & assessment Increase use of technology Build relationships

19. Strategies for Mental Health Programs Client/Patient • Identify Health Status and PCP coverage • Increase the number of clients with a PCP • Include Releases of Information to PCP’s as part of intake • Assist clients in using primary care Practice • Educate PCP’s about mental health problems • Establish process to routinely coordinate care • Establish method to identify clients at high risk • Create process for collaborative planning for high risk populations • Build relationships

20. People Challenges Attitudes and experience Struggles with communication Personalities Competing demands Geographic separation Turf

21. People Strategies “No wrong door” Collaborative learning Teams and disciplines come together Introductions and ongoing informal connecting Offer site visits, conference calls, Webinars Be responsive Foster relationships/communication

22. Connecting at all Levels • Leadership: The right culture - an agency-wide culture shift is necessary to make these changes. Business as usual will hamper integration. • Practice: The right training - provide staff the tools and knowledge to work within an integrated health program. • People: The right people - all staff, down to the front office, must understand the importance of integrated services and why the agency provides these services. From the SAMSHA-HRSA Center for Integrated Health Solutions

23. Tips for Connecting • Build and nurture relationships • Focus on communication and coordination • Clarify Roles • Establish shared goals

24. Lessons Learned Leadership Be aware of organizational power and politics Money matters Practice/Program Acknowledge when turf is being challenged, or protected Pause to look at the big picture, and remind others to do so People Expect variability; some people will see the larger picture, others will not Patients/clients and families are valuable teachers in the collaborative process

25. Lessons Learned – at all levels Everything takes much more time than you thought it would (or should)! Foster linkages and relationships and sustain them Be willing to work at many levels at the same time There will be blind spots. Watch for them. Grab all opportunities: even the smallest steps can create positive change Be open to what is not working and why: be prepared to make significant changes in perception and direction

26. Tools for Connecting at the Practice Level • Readiness survey: for primary care and Readiness Survey with Change ideas • AIMS Center “Staff Self-assessment”:from the IBHP Partners in Health Interagency Toolkit • Tips:for Connecting Primary Care and Behavioral Health Organizations

27. Activity • What can you do to make improvements in the connection, and how will you start this process? • What are you willing to commit to doing when you get back to work?

28. Resources www.thenationalcouncil.org – the National Council for Community Behavioral Healthcare www.ibhp.org – Integrated Behavioral Health Project www.mainehealth.org/mentalhealthintegration

29. Contact Information Cynthia Cartwright, MT RN MSEd cartwc@mainehealth.org Melissa Cormier, LCSW cormim@springharbor.org Mary Jean Mork, LCSW morkm@mmc.org