Mental Health Service Corps Presentation for OneCity Health

Mental Health Service Corps Presentation for OneCity Health

DSRIP Project 3ai: Integration of Primary Care and Behavioral Health Model 1: Co location of BH into Primary Care Setting Model 2: Co location of Primary Care into BH Setting ( reverse co location ) Model 3: IMPACT Model ( Improving Mood Access to Collaborative Treatment ) o Utilize IMPACT Model (University of Washington) for screening and collaborative treatment of depression. o Key components of the IMPACT model: Collaborative depression care: Patient s primary care physician works with a depression care manager to develop and implement a treatment plan Outcomes measurement: Monitor progression of symptoms using PHQ 9 or similar tool Stepped care: Adjust treatment using evidence based algorithm Depression care manager: Licensed clinical professional (e.g. RN, SW, psychologist) educates patient, supports adherence, provides coaching and brief counseling, monitors symptoms for response, develops relapse prevention plan Designated psychiatrist/psychiatric NP: Care manager and primary care provider consult with psychiatrist/psychiatric NP to change treatment plans if patients do not improve *Do not need to be participating in Project 3ai with OneCity Health in order to apply to MHSC 2

Additional Support from OneCity Health 3 MHSC is a free standing program; any eligible practice may apply Supports/provides staffing resources to practices doing the IMPACT model/collaborative care Additional support from OneCity to assist sites in doing the IMPACT model/collaborative care: o Training and Technical Support o Registry functionality o Financial Sustainability

Agenda 1. 2. 3. 4. Introduction to Mental Health Service Corps Behavioral Health Integration for Primary Care Eligibility and Application Walk Through Q&A 4

Introduction to Mental Health Service Corps

Introduction to Mental Health Service Corps MHSC is a key initiative of Thrive NYC: A Mental Health Roadmap for All, a comprehensive public health approach to mental health Goal of MHSC is to fill gaps in mental health care throughout NYC by placing 400 mental health clinicians in high-need communities Specific focus on evidence-based practices and engaging with communities 6

Who Are MHSC Corps Behavioral Health Clinicians? Clinically trained masters and doctoral level mental health counselors and social workers and psychiatrists Committed to working in high need communities with barriers to mental health care. MHSC behavioral health clinicians are selected to meet the needs of the communities based on: Previous experience Ability to speak the languages Capacity to understand the cultural needs specific to the patient population MHSC behavioral health clinicians must commit to three years of service, and the clinical hours they provide will count towards their clinical licensure. 7

Mental Health Service Corp 8

Costs/Benefits to Primary Care Practice MHSC services are free to the sites Practices may need to cover the costs associated with the behavioral health clinician's access to electronic health records Practice need to ensure a private space for behavioral health clinician's consultation with patients Services provided by the MHSC behavioral health clinician cannot be billed MHSC behavioral health clinicians can help with capacity concerns and/or enable new models or service possibilities for care, which are often not well supported by reimbursement and difficult to start up 9

Behavioral Health Integration for Primary Care

Practice Transformation with the Collaborative Care Model Primary care providers play a vital role in identifying, preventing, and treating depression, anxiety and substance abuse The Collaborative Care Model is an evidence-based model where patients are cared for through core principles Patient-centered team care primary care and behavioral health providers collaborate using shared care plans Population-based care care team shares a defined group of patients tracked in a registry to ensure fully physical and mental health care is delivered within a single location Measurement-based treatment to target patient s treatment plans are routinely measured by evidencebased tools, such as the PHQ-9 depression scale Evidence-based care patients are treated with credible research evidence to support their efficacy in treating the target condition In an unprecedented venture, the MHSC will expand the use of the collaborative care model beyond depression to include anxiety and substance use 11

Typical Collaborative Care Structure 12

MHSC Collaborative Care Team Structure MHSC Behavioral Health Clinician MHSC Psychiatrist 13

Phase 1: Collaborative Care Model and Depression Care Management Targeted Time Frame: 1 to 6 Months Implementation Plan: Integrate structured data and clinical decision support in EHR to support MHSC behavioral health clinician to: Screen patients for depression and suicidality using a validated screening tool Document severity of score and interpretation from screening tool Facilitate feedback loop to PCP and Consulting Psychiatrist Plan for appropriate follow-up Document follow-up visits and re-assessments 14

Screening, Brief Intervention and Referral to Treatment (SBIRT) SBIRT is an evidenced-based practice designed deliver early intervention and treatment for individuals at risk of developing and who have developed substance abuse disorders Mental Health Service Corps will use SBIRT in coordination with the Collaborative Care Model in order to screen, assess and treat patients 15

Phase 2: Screening, Brief Intervention and Referral to Treatment (SBIRT) Targeted Time Frame: 6-9 months Implementation Plan: Integrate structured text and clinical decision support into EHR to support MHSC behavioral health clinician to: Universally screen patients for alcohol and drug use using a validated screening tool (e.g. AUDIT, DAST) Document severity of score and interpretation from screening tool Facilitate communication between PCP and MHSC clinician Plan for follow-up assessment and documentation 16

Targeted Time Frame: 9 to 12 months Phase 3: Assessment for Generalized Anxiety Disorder Implementation Plan: Integrate structured text and clinical decision into EHR to support the integration to support MHSC behavioral health clinician to: Universally screen patients for Generalized Anxiety Disorder using a validated screening tool (e.g. GAD-7) Document severity of score and interpretation from screening tool Facilitate feedback loop to the PCP and the MHSC clinician Plan for follow-up Document follow-up visits inclusive of re-assessment 17

Eligibility and Application Walk Through

MHSC Eligibility Criteria To be eligible to join the MHSC, behavioral health and primary care practices must: Designate a representative within the practice or site to be the lead contact for MHSC Dedicate staff who can provide onsite support, task supervision and crisis support to MHSC behavioral health clinicians Be located in a high need area and/or serve a high need population Demonstrate a need for additional mental health clinicians Have appropriate clinical and work spaces for behavioral health clinicians and patients Be willing to participate in on site trainings offered by MHSC program to facilitate integration services Use the MHSC to advance the use of best practice models and expand access to mental health and substance use care 19

First Step: Application Worksheet Gather pertinent information about practice and sites to be inputted in MHSC application Affiliations Leadership Provider Champion and contact at the practice Relevant Policies Patient Panel Data Staffing Specialties and Structure Access to space Exam rooms Consult areas EMR access Enrollment Justification 20

MHSC Application Site completion expected to take about 35 minutes For practices with multiple sites, the MHSC Application for primary care requires completing questions for both the practice and site level Be sure to note your affiliation with the OneCity Health PPS Utilize save and continue feature at the bottom of the page 21

Key Information Practices Will Share in the Application Patient Panel at site-level of > 1500 patients per year Sites which operates full-time, multiple days a week for at least 40 hours/week Practices who have a site champion for BH integration and fully informed and cooperative staff at the site-level Sites who have demonstrated experience with Quality Improvement activities Sites who are conducting Collaborative Care lite 22

Next Steps Submit your application early as there are a limited number of MHSC members. Recommend complete application by February 15, 2017 Site selection for matching with MHSC behavioral health clinicians will begin April 1, 2017 We will notify sites of MHSC member placement by May 1, 2017. What should I do next? Visit NYCREACH.org Download MHSC worksheet Complete MHSC application 23

Questions?

Contact Information Emily Carroll ecarrol@health.nyc.gov