Integrated Care. What s missing in Current Practice Models? Disclosure. APNA 27th Annual Conference Session 2025: October 10, 2013.

Transcription

1 Integrated Care What s missing in Current Practice Models? Roberta Waite, EdD, APRN, CNS-BC, FAAN Carla Groh, PhD, PMHCNS-BC APNA 27th Annual Conference, October 9-12 in San Antonio, Texas. Disclosure The speakers have no conflict of interest to disclose. LEARNING OBJECTIVES Recognize different levels of integrated care Identify how we can work effectively in systems of integration using a social justice approach Share examples of two nurse-managed centers that implement integrated care and describe their mission/guiding principles as it aligns with social justice 3 Waite, Groh 1

2 What is Integrated Care? Focuses on the whole person Is seamless and coordinated care INTEGRATED CARE Includes a continuum of services Is multi-level care addressing physical and behavioral health needs 4 Primary Care: Behavioral Health Blount (1998) Integrated primary care behavioral health combines medical and behavioral health services to more fully access the spectrum of problems that patients bring to their primary medical care providers. It allows patients to feel that, for almost any problem, they have come to the right place. Delivering the RIGHT Care, at the RIGHT Time, in the RIGHT Place. 5 Levels of Integration Coordinated Co-located Integrated Referred to specialist Different setting, Separate records Both services provided in the same location Referral process still needed Medical and behavioral health components within one treatment plan Team approach to treatment 6 Waite, Groh 2

3 Advantages of Integrated Care Improved access to care; Improved quality of care; Improved health outcomes; Improved communication between providers; Cost effectiveness; Minimization of stigma and discrimination. 7 Limitations of Integrated Care Multiple models and levels of integration; Limited number of patient outcome studies; Funding and financial sustainability; Billing & coding differences; Extensive need for staff education; Professional territoriality. 8 Work effectively in systems of integration: Using a social justice approach What is social justice? Term coined by Jesuit priest in 1840 Multiple definitions Fundamentally means: Society based on principles of equality and solidarity, values human rights and dignity of every human being 9 Waite, Groh 3

4 Social Justice Social justice guiding principle in healthcare: Commitment to the advancement of human well-being; Aimed to improve the lives of the systematically disadvantaged; Goal to advance the common good by showing equal respect to all individuals and groups 10 Case Example #1: Integrated Care We put the patient first and follow a model of care that uses our resources wisely to provide for the needs of our patients, our staff and our community. Guiding Principles We work in partnership with the community and the University to improve the health status of the community We provide services based on community defined needs We provide access to high quality health care for all regardless of their ability to pay 12 Waite, Groh 4

5 We collaborate and communicate with integrity to support an environment of trust and respect among our patients/clients, staff and community Guiding Principles We are dedicated, enthusiastic, highly skilled staff who are committed to providing care and service. We value diversity, respect the dignity of all and accept the uniqueness of individuals. We promote innovation and a willingness to try new approaches with vitality, energy and enthusiasm to support change and foster growth 13 Guiding Principles & Social Justice Prevention of disease by promoting healthful environments in communities Strengths-based, person-in-environment perspectives which allows us to see beyond the illness/disability to the social, behavioral and environmental determinants of health Focus on development across the life span and work with persons of all ages. Focus on whole families and communities, connecting with families and assisting them to manage their care plans, and prevention plans. Offer important insights among team members about environmental factors contributions to physical and mental health. 14 All Services at 11 th Street FHS 15 Waite, Groh 5

6 Safe place: Knitting Growing together: Parenting Growing together: Pregnancy 16 Relationship Based Practice Early ID of developmental, behavior and health concerns Helps establish a foundation for supporting healthy family behaviors and promoting mental health Learn normal development Waite, Groh 6

7 Opened in 2002 Funded by HRSA Located on the eastside of Detroit Designed MUA and HPSA High level of poverty and unemployment High levels of crime 19 Services provided: Birth to death Acute, episodic, chronic disease management Health education Immunizations 20 Providers: 1.7 FTE Family Nurse Practitioners 2 PT (.1) FNP for WiseWoman Program 1 PT (.1) Adult Nurse Practitioner 2.6 FTE Medical Assistants 0.6 Financial/Data Manager Collaborating physician 21 Waite, Groh 7

8 Integrated Care consists of: Primary and preventive care Mental health services Special Personal Assistance services BCCCP and WiseWoman Nutrition and cooking classes Exercise classes Knit and crochet classes 22 References Pratt, K., & Lamson, A.ngela L, PhD,L.M.F.T., C.F.L.E. (2012). Supervision in behavioral health: Implications for students, interns, and new professionals. The Journal of Behavioral Health Services & Research, 39(3), Blount, A. ed.(1998). Integrated Primary Care: The Future of Medical and Mental Health Collaboration. New York: Norton. Carpenter-song, E., Whitley, R., Lawson, W., Quimby, E., & Drake, R. E. (2011). Reducing disparities in mental health care: Suggestions from the dartmouth-howard collaboration. Community Mental Health Journal, 47(1), Gerrity, P. (2010). And to think that it happened on 11 th street: A nursing approach to community-based holistic care and health reform. Alternative Therapies in Health and Medicine, 16(5), Drexel University College of Nursing and Health Professions.(2013) Questions & Discussion 24 Waite, Groh 8

9 Thank You! Roberta Waite, EdD, APRN, CNS-BC, FAAN Carla Groh PhD PMHCNS-BC 25 Waite, Groh 9