Integration of Primary and Behavioral Health in DPH Primary Care Clinics Prepared by: Marcellina A. Ogbu, DrPH - Director, Community Programs Michelle Schurig - Office of the Controller, City Services Auditor Division Maureen O Neil, LCSW - Primary Care Behavioral Health Manager, COPC April 19, 2011 1
Background Integrated care delivers coordinated mental health, substance abuse and medical care to patients in one setting. 70% of patients in primary care have either a physical ailment that is affected by stress, problems maintaining healthy lifestyles or a psychological disorder. Traditionally, DPH has provided care through two separate systems, which is ineffective since patients must go to different clinics to receive care. Community Programs 2
Background Research indicates that there are many benefits associated with integrative care: An overall improvement in depression treatment rates, from 42% to 71%. An improvement in patient self management skills, for example, understanding of adherence issues in the setting of patients with chronic conditions such as diabetes. An offset in health care costs due to reduced use of specialty mental health services. Integrated care results in an offset in indirect health care costs due to having a more efficient system. Community Programs 3
Background Stakeholders recommendation The City and County of San Francisco contracted with Public Consulting Group, Inc. (PCG) to assist in the integration of behavioral health and primary care services provided through DPH and contracted nonprofit providers. PCG works in partnership with Mountainview Consulting Group, Inc (MVCG) and Diamond Technology, Inc (DTI). The project began in November 2009 and is ongoing. Community Programs 4
Background In 2009, the Controller s Office contracted with Public Consulting Group (PCG) to guide DPH in implementing integrated care DPH decided to implement the Primary Care Behavioral Health Model in DPH primary care clinics Community Programs 5
Project Components Phase I: Readiness Reviews Conducted multiple visits to 17 clinics, including an analysis of current operations and data Prepared findings and recommendations for each clinic in a Readiness Review Report Facilitated 10 system-wide trainings Phase II: Implementation Training PCG has developed a program manual, training and implementation tools, and IT. Community Programs 6
Project Timeline Readiness reviews in 17 clinics and debriefs Go Live Trainings in clinics Core Competency Trainings in clinics with primary care clinic staff Jan 2010 Dec 2010 Dec 2010 March 2011 April 2011 March 2012 Phase 1 Phase 2 Community Programs 7
Clinic Focus Staffing Two new Behaviorists and Behaviorist Assistants per clinic Several DPH Medical Social Workers are now Behaviorists 11 Behaviorist Assistants - 5 Transfers from CBHS - 5 New hires from 2930 List A Behaviorist Supervisor will be hired Community Programs 8
Clinic Flow The 30-Minute Behaviorist Intervention Community Programs 9
Clinic Focus Staffing Primary Care Provider Helps patients with their physical and mental health needs. Nurses and Medical Evaluation Assistants are also key members of the primary care team Behaviorist The primary care provider may refer patients to a behaviorist for a 15-30 minute visit. Behaviorist Assistant The behaviorist assistant connects patients to community and social service resources and case management. Community Programs 10
Clinic Focus Scheduling and Referring Advanced access scheduling Schedule evolves / warm hand-offs Referrals are made by the Primary Care Provider Patients who are considered seriously mentally ill may be referred to specialty mental health Some reasons for referral to the PCBH program may be: Alcohol/Drug Anger Anxiety Grief Healthy Eating Physical Activity Relationships: IPV Trauma Community Programs 11
Chart I. Referral from Primary Care to Behavioral Health (Step-Up/ Step-Down) Primary Care Provider BH Issue Behaviorist / Behavioral Assistant Refer Back to Primary Medical Home Mild to Moderate BH Need Behavioral Consultation in Primary Care Crisis / Urgent Care High BH Need Behaviorist Step-Up / Step-Down Assessment PES Mobile Crisis DORE Child Crisis CASARC Co Located BH Clinic BHAC Neighborhood BH Network COPE Other Specialty BH Issues Resolved Community Programs 12
Flow Sheet Community Programs 13
Clinic Focus Information Technology Behaviorists and behaviorist assistants will use wireless mobile devices in the clinics to capture electronic patient data. Community Programs 14
Clinic Focus Performance Measures Patients Quality of Life Access to Health Services Patient / Provider Experience Fidelity to the Model Productivity Community Programs 15
Accomplishments to date Number of visits since February 1, 2011: 1,786 visits Staff Trained: 28 Total - 17 Behaviorists - 11 Behaviorist Assistants All have arrived at the health centers IT pilots have begun at 3 sites: MHHC, CMHC, OPHC Community Programs 16
Next Steps Core Competency Training There will be two five day core competency trainings at each of the DPH COPC clinics. Core competency evaluations of PCBs and BAs Training of PCPs, RNs, and MEAs in clinical areas Re-survey staff using Integration Tool Optimal use of PCBH resources Creation of pathways and pathway materials Identification of best practices, mentor training activities Community Programs 17
Next Steps (cont.) Core Competency Training Schedule DPH COPC CLINICS Castro Mission Health Center Week of 4/18/11 Maxine Hall Health Center Week of 5/9/11 Ocean Park Health Center Week of 6/13/11 Southeast Health Center Week of 6/6/11 (CHPY) - Cole Street Week of 8/1/11 (CHPY) - Larkin Week of 8/1/11 Curry Senior Center Week of 8/15/11 Chinatown Public Health Center Week of 8/22/11 Silver Avenue Family Health Center Week of 9/12/11 Potrero Hill Health Center Week of 9/26/11 Housing and Urban Health Tom Waddell Health Center TBD TBD Community Programs 18
Questions? Community Programs 19