A Guide to Behavioral Health Screenings: Part 4 Behavioral Health Referrals and Community Resources

Transcription

1 A Guide to Behavioral Health Screenings: Part 4 Behavioral Health Referrals and Community Resources

2 About the Presenters Rebecca S. Fuller MA, LPC Behavioral Health Lead Project Coordinator More than 20 years of experience in health care, specializing in behavioral health Licensed Professional Counselor in Oregon On board of directors for NAMI Oregon Christopher Wells, MPH Practice Facilitator Served as a research coordinator for a private neuropsychiatric practice Experienced in behavioral health and holistic approaches to mental and physical health Master of Public Health from UCLA 2

3 Available online: healthinsight.org/improving-behavioral-health A Guide to Behavioral Health Screenings Module 1: online Utilizing Screening tools to Improve Identification of Depression and Alcohol Misuse in Primary Care Module 2: online The ABCs of Scoring and Interpreting Behavioral Health Screens Module 3: online Monitoring Patients to Symptom Remission Module 4: September 14, 2016 Behavioral Health Referrals and Community Resources

4 Today s Learning Objectives 1. Be able to recognize when a behavioral health referral is clinically indicated 2. Understand the different provider types available to make an effective referral 3. Have an improved understanding of community resources

5 Discussion Questions What specific knowledge are you looking to learn about in today s webinar? Please chat in your feedback, and we will try to focus on areas of interest.

6 Poll Question How many of you are prepared to assist your patients to receive behavioral health care specialty services?

7 Overview This presentation will help prepare primary care providers and staff with tools and knowledge to decide when it is appropriate to refer patients to a behavioral health provider. Additional content will include: Behavioral health provider types Information on referral processes Community resources A discussion on challenges and opportunities for change

8 Agenda 1. Referrals to specialty services 2. Provider type Community resources 4. Challenges for patients and providers 5. Questions and discussion

9 Referrals to Specialty Services

10 Referral to Specialty Behavioral Health Providers Three indicators that might elicit a referral for specialty behavioral health services: 1. New diagnosis of an acute behavioral health disorder or the reoccurrence of a previously diagnosed BH disorder 2. Existing or new environmental/social stressors that would complicate a patient s ability to engage in treatment 3. Chronic medical or co-occurring disorders/illnesses

11 When to Refer 1. New diagnosis or reoccurrence of an acute behavioral health disorder Significant change in emotions/behavior without precipitation Symptoms that elevate risk of self-harm or harm to others Substance abuse or misuse Significant disruption of Activities of Daily Living (possible need for Social Services referral in addition to BH referral) Psychosis Recent psychiatric hospitalization Complex diagnostic criteria requiring direction from BH specialist

12 When to Refer 2. Existing or new environmental/social stressors that would complicate a patient s ability to engage in treatment. Unstable housing, financial hardship, domestic violence Limited family or social supports Significant life stressors including: divorce, unemployment, death of a family member History of abuse or neglect by either the patient or persons close to the patient Note: Some of these stressors (possible abuse or neglect) may prompt a protective services or social services referral as well as a BH referral

13 When to Refer 3. Chronic medical or co-occurring disorders/illnesses New or ongoing significant acute or chronic physical illnesses History of adverse effects from psychotropic medications Previous course of treatment without therapeutic response Behavioral or emotional issues that may prevent or interfere with the proper treatment of a chronic or recurrent medical condition

14 What s Next? A referral is needed: What type of provider will be the best fit for the patient? There are many types of behavioral health providers to choose from.

15 Provider Type 101

16 Types of Behavioral Health Specialists Psychiatrist (M.D., D.O.) Medical Doctor or Doctor of Osteopathic Medicine Can specialize in certain populations (geriatric psychiatry) Can provide a mental health diagnosis Can prescribe medication or provide psychotherapy

17 Types of Behavioral Health Specialists Psychologist (Ph.D., Psy.D., Ed.D.) Provides psychotherapy in a group or one-on-one setting Able to provide psychological testing and can perform psychological disability evaluations Cannot prescribe medications, but can work with providers who may

18 Types of Behavioral Health Specialists Psychiatric Mental Health Nurse Vary in level of degree from RN to more advanced degrees such as CPN (Certified Nurse Practitioner) or DNP (Doctorate of Nursing Practice) Available services that can be provided vary by training, degree and state law May diagnose and treat behavioral health issues May prescribe medication depending on degree and state law

19 Types of Behavioral Health Specialists Physician Assistant (P.A.) Practices medicine and can specialize in psychiatry under the auspices of a medical doctor Certified P.A.s (P.A.-C.) can diagnose and treat mental illness through providing psychotherapy or prescribed medication

20 Types of Behavioral Specialists Licensed Clinical Social Worker (L.C.S.W., M.S.W., D.S.W.) and Licensed Professional Counselor (L.P.C.) Has obtained a graduate level degree with clinical credentials Provides diagnosis, psychotherapy and various other services depending on specialization and training Cannot prescribe medication, but can work with providers who may

21 Referral Forms/EHR/Closed Loop Referral A referral process can be via paper/fax or be completed in a EHR in certain systems. Decide on a process to ensure that the referral loop is closed.

22 Closing the Referral Loop 1 - Goals Improve processes related to physician-to-physician referrals including the patient Establish accountability and negotiating responsibility for referrals between specialists and primary care physicians (PCPs) Improve satisfaction with the referral process among physician, office staff and patients Ensure EHR communication compatibility between practices to confirm referrals are communicated and closed in a timely manner and identify those that are not 1. Closing the Referral Loop Project. Web. 13 Sept Available:

23 Closed Loop Referral Work Flow

24 Community Resources

25 Community Resources Of many available community resources, the following are examples of exceptional organizations that serve Oregon, Nevada, New Mexico and Utah NAMI National Alliance on Mental Illness Project ECHO - Extension for Community Healthcare Outcomes

26 National Alliance on Mental Illness About NAMI 1 : Mental health organization dedicated to building better lives for the millions of Americans affected by mental illness Association of hundreds of local affiliates, state organizations and volunteers that raises awareness and provide support and education to those in need Started as a small group of families gathered around a kitchen table in 1979 About NAMI Web. 13 Sept Available:

27 NAMI Programs Peer-led programs provide free education, skills training and support Offered in a wide variety of settings: Churches Schools NAMI Affiliates

28 NAMI Education Classes and Programs NAMI Basics: class for parents and other family caregivers of children and adolescents who have either been diagnosed with a mental health condition or who are experiencing symptoms but have not yet been diagnosed

29 NAMI Education Classes Continued NAMI Family-to-family: class for families, partners and friends of individuals with mental illness Designed to facilitate a better understanding of mental illness, increase coping skills and empower participants to become advocates for their family members Designated an evidence-based program by SAMHSA

30 NAMI Education Classes Continued NAMI Peer-To-Peer: recovery education course open to anyone experiencing a mental health challenge Designed to encourage growth, healing and recovery among participants

31 NAMI Education Classes Continued NAMI Provider Education: class for line staff at facilities providing mental health treatment services Designed to expand the participants' compassion for the individuals and their families and to promote a collaborative model of care

32 NAMI Support Groups NAMI Connections: weekly or monthly support group for people living with a mental health condition NAMI Family Support Groups: weekly or monthly support group for family members, partners and friends of individuals living with a mental illness Programs#sthash.TM8LfoPY.dpuf

33 NAMI Outreach and Advocacy NAMI Smarts For Advocacy: hands-on advocacy training program that helps people living with mental illness, friends and family transform their passion and lived experience into skillful grassroots advocacy

34 Project ECHO Project ECHO Extension for Community Healthcare Outcomes Collaborative model of medical education and care management Empowers clinicians to provide better care to more people, right where they live

35 Project ECHO cont. Project ECHO is helping to address: Inadequate or disparities in access to care Rising costs Systemic inefficiencies Unequal or slow diffusion of best practices

36 Challenges for Patients and Providers

37 Challenges Provider Challenges in Behavioral Healthcare Understanding individual landscape of your practicing area Shortage of Medicare Behavioral Health Providers Getting past the stigma (for both patient and providers) Poverty, co-pays and difficulty understanding parity contribute to beneficiaries being unable to obtain proper behavioral healthcare

38 Possible Solutions Work with community partners to build and share behavioral health providers resources Share a behavioral health provider among several practices in local areas Investigate becoming a integrated practice

39 39

40 Questions, Discussion, Sharing Please chat or join the call with questions or comments Thank you so much for joining us today! We appreciate your feedback and ideas about our webinar series.

41 Oregon Resources NAMI: Project ECHO: Aging and Disability Resource Connection: PSU School of Community Health: Institute on Aging:

42 New Mexico Resources NAMI: Project ECHO: State of New Mexico

43 Nevada Resources NAMI: Project Echo:

44 Utah Resources NAMI: Project ECHO:

45 Other Resources Example Referral Form: %20Providers/Forms/Behavioral%20Health/bhreferralform.pdf MDWise Behavioral Health Tool Kit %20Providers/Tools%20and%20Resources/Toolkits/b h-toolkit.pdf

46 Contact Information New Mexico Nevada Remona Benally Jackie Buttaccio (505) Oregon Utah Rebecca Fuller, MA, LPC Janet Tennison, PhD, MSW, LCSW (801) This material was prepared by HealthInsight, the Medicare Quality Innovation Network-Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-G