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Care Support and System Innovation Program Presentation
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Integrating Mental Health into the Medical Home
May 2011
Portland Family Practice
Aim
Improve screening, identification, and treatment referral for adult and adolescent patients who are high risk for substance abuse and depression
Objectives
Hire mental health professional for expertise and assistance with program development
Integrate mental health professional into existing family practice model
Identify patients who are at risk for depression & substance abuse; assess co-morbidity
Provide mental health services directly or refer to appropriate outside providers
Hiring for the right fit
Hired licensed psychologist, Pat Blumenthal, PsyD
Experience in providing individual & family therapy Experience with using screening tools and collection
of outcome data Experience with managed care and insurance Experience in program development
Teamwork
Coordinated efforts with: Information Technology Physicians & Medical Assts Intake/Triage Case managers in Medical
Home Front Office staff Schedulers Billing & Benefits
Reporting
Coordinationof Services
Training
Referrals
IT WorkflowSet up
Mental Health
Objectives & Measures
All patients given the PHQ-9; teens given additional CRAFFT
Scores documented in medical record
Scores above threshold identified for mental health referral
PHQ-9 Questions
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating6. Feeling bad about yourself—or
that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead, or of hurting yourself in some way
CRAFFT Questions
• C—Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
• R—Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
• A—Do you ever use alcohol/drugs while you are by yourself, ALONE?
• F—Do you ever FORGET things you did while using alcohol or drugs?
• F—Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
• T—Have you gotten into TROUBLE while you were using alcohol or drugs?
Visibility
Methods of Promoting Awareness of Mental Health Services
Screening tools given to patientsDialogue between PCP – Patient about mental
health issuesPosters in all exam roomsWebsite presence with Mental Health blog “Curbside Counseling”, seamless introductions
Mental Health Services
PCPs give patient recommendation for counseling based on score.
For many patients, PCP offers chance to meet Dr. Blumenthal to make initial contact or to schedule appointment before leaving office.
If unable to meet initially, Dr. Blumenthal contacts the patient by phone to offer services.
PHQ-9 Results
Adult PHQ-9 Results
8%n = 269
91%n=3001
1% n=20
PHQ-9 POS Adults
PHQ-9 POS Adol
Negative Results
89%n=82
11% n=11
Positive Results
Negative Results
CRAFFT Results
Lessons Learned
• Hiring
• Credentialing & Insurance Issues
• Training & workflow
• Provider Involvement
• Confidentiality
• IT challenges
• CRAFFT (parents)
• Consistency
Identification & Referral underway
• In-house treatment• Phone outreach• Tracking• Referrals• Re-test
Success Stories
59 year old breast cancer patient
52 year old female with recent suicide attempt
28 year old male, unable to work
• Follow up - Therapy outcomes
• Utilization patterns
• Continued outreach
Next Steps
Project Team
• Bunny Meharry, RN, BA– Clinical Operations Manager
• Cindi Bourn– MA/IT EHR Manager
• Pat Blumenthal, PsyD– Clinical Psychologist
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