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The Primary Care Behavioral Health Model

The Primary Care Behavioral Health Model. Creating Access, Impacting Populations. Elizabeth Zeidler Schreiter , PsyD Behavioral Health Consultant Consulting Psychiatry Lead Access Community Health Centers Madison, WI. Access Community Health Centers.

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The Primary Care Behavioral Health Model

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  1. The Primary Care Behavioral Health Model Creating Access, Impacting Populations • Elizabeth Zeidler Schreiter, PsyD • Behavioral Health Consultant • Consulting Psychiatry Lead • Access Community Health Centers • Madison, WI

  2. Access Community Health Centers • Federally Qualified Health Center (FQHC) • 3 clinic locations in Madison, WI • William T. Evue Clinic and Wingra Family Medical Clinics have Patient Centered Medical Home Certification • Medical, Dental, Pharmacy and Behavioral Health Services • Over 26,000 residents seen in 2013 (over 80,000 office visits) • Over 10,000 behavioral health visits

  3. When asked, • patients say they • prefer their care here • 80% visit PCP in a given year • Chronic Disease • Obesity • Smokers • 10-50% • Referral Completion Rate • Primary Care “De Facto” Mental Health System

  4. Provider Area • Exam Rooms • Hallway • Severe Depression, Multiple somatic complaints • = PCP • = BHC

  5. What a consultant does: • brief consultations focused on quality of life and daily functioning • increase skills of providers via curbside consults • provide assistance for medication management & adherence • Phone-based consultation for patients & Assistance with behaviorally related calls to triage/ call center • manages other related services such as care management and consulting psychiatry • exerts leadership in areas such as patient-doctor communication, crisis management, staff response to difficult patients • Curbside Consult • Scheduled f/u • Warm hand-off

  6. PCBH: The Benefits of Integration Aims to meet the primary care needs and support PCPs De-fragments and De-stigmatizes care Allows collaboration in the moment Reduces psychological and social barriers Promotes cross-education and reciprocal learning Supports use of evidence based treatment Provides population based care Increases access to care

  7. Consulting Psychiatry • Population based approach which maximizes the skills of the psychiatrist to enhance the skills of the PCP • BHC & some PCPs present patients to the psychiatrist at weekly meetings, receiving verbal and written recommendations • Psychiatrist then works with BHC to select patients on a weekly basis to see for ‘one-time’ evaluations • PCP retains prescribing role & is cross-trained in primary care psychiatry through this process (as are the BHCs)

  8. Steps Toward Implementation-Consulting Psychiatry Behavioral Health Consultation and Consulting Psychiatry started at Access in 2007 Administrative backing Population care focus thus emphasis on verbal and written consultations in addition to face-to-face encounters Psychoeducation for medical providers Space for psychiatry consultant to work (e.g. exam room) Finding a psychiatrist ready, willing, and able to thrive in this environment Utilization of Behavioral health consultant to assist with triaging need and appropriate allocation of resources

  9. Care Management • Quarterly reviews of patients in 4 categories (depression, ADHD, pediatrics, consulting psychiatry) • Registry is populated with over 3,000 patients • Results in thousands of phone calls annually to engage patients along with cues to the medical team

  10. PCBH In Action at Access • 5.5 FTE Psychologists/Social Workers; .25FTE Consulting Psychiatrist • Train 5-10 psychology and social worktrainees annually & 8 psychiatry residents annually • 1 in 5 medical patients annually sees a BHC • Over 400 consulting psychiatry chart reviews and 208 face-to-face consults in 2013 • Over 3000 care management chart reviews

  11. Research Supports PCBH • Ray-Sannerud et al. (2012) Patients significantly improved using global measure of mental health functioning two years post contact with BHC • Corso et al. (2012) Patient self-report of therapeutic alliance with BHC exceeded outpatient specialty mental health alliance • Reiss-Brennan et al. (2010) Intermountain Health System shows high patient satisfaction, improved utilization and quality outcomes

  12. Recommended Resources • Robinson, P., & Reiter, J. (2006). Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer. • Serrano, N. (Ed.) (2014). The Implementer's Guide To Primary Care Behavioral Health. iTunes Store. Access Community Health Centers. • Access Community Health Centers (Access) Integrated Primary Care Consulting Psychiatry Toolkit 2013. Available from: http://www.hipxchange.org/Access. • Collaborative Family Healthcare Association (www.cfha.net) • Email Contact: elizabeth.zeidlerschreiter@accesshealthwi.org

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