BRIDGING THE GAPRachael Bowers, LICSWNandini Sengupta, MD

April 3, 2013

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

OUR MODEL – WHO WE ARE

5 Primary

Care Providers

1

Pediatric Social

Worker

3 Licensed

Behavioral Health

Clinicians

1Child

Psychiatrist(1

day/week)

3,000 PatientsBH served 221 Patients (7%)

3,784 Encounters

OUR MODEL – WHAT WE DO

Individual and Family Therapy

Psychiatry (weekly)

School-Based Behavioral Health Services

Consultation to PCPs during medical appointments

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

CO-LOCATION

Fall 2013: Rate of referral = 16/month

CONSTRUCTIONBHPIP 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

WARM HAND-OFF

Tracking began July 1, 2013

Intakes Completed

With Warm Hand-off69%

Without Warm Hand-off25%

WARM HAND-OFF

CONSTRUCTION

July - November 2013: WH rate 53%

December 2013 – February 2014: WH rate 21%

BRIDGING THE GAP

Intake

Clinician

“Translator”

Referral Coordinator

Liaison

Pediatric Social Worker

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

OUTCOMES II - QUALITY OF CARE

COMPLIANCE WITH INTAKE: 67% Rough estimate of compliance pre-integration: ~30%

OUTCOMES III – FINANCIAL SUSTAINABILITY

Cost Neutral by the end of second Fiscal Year

More streamlined/efficient use of Employee Time

OUTCOMES IV - MORALE 1. Mutual Respect of Providers’ Disciplines

2. Frequency and Quality of CommunicationLeading 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 Information about Treatment (for MD)

4. Role of SW to facilitate the process from both MD and BH perspectives

5. Feeling of support and efficacy in role (BH)

EXPANSION

OBHI(Ob/Gyn and Behavioral Health

Integration)Launched November 1, 2013

Funded by Children’s Hospital

1.Introduction of BH services at New OB appointment2.MH Screening at prenatal and post-partum appointments3.Access to BHPIP for services when needed or requested

WHERE NEXT?

Behavioral Health Consultations

1. Increase: Could we reach more than 7% of Pedi patients?

2. Billing???

WHERE NEXT?

Could we integrate care of chronic conditions?

WHERE NEXT?

How do we redefine the “closed” BH case?