Dawn M. Graham, PhD Assistant Professor of Family Medicine Ohio University College of Osteopathic Medicine Jane Hamel-Lambert, PhD, MBA Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine Joint AACOM & AODME 2011 Annual Meeting April 13, 2011
IOM (2003) Health Professional Education: A Bridge to Quality called for workforce competencies in interdisciplinary teamwork IOM (2005) Quality Through Collaboration: The Future of Rural Health Care Principals of Patient-Centered Medical (Health Care) Homes (2007 Jt. Principals) Team care is coordinated National dialogue on Core Competencies for Interprofessional Practice
Describe the success of a four county, rural health network in Southeastern Ohio with building interagency, interprofessional partnerships. Highlight lessons learned from our community-based programs, focusing on the integration of behavioral health and primary care Implications for Interprofessional Education
Vertical network: mental health, medicine, speech language, audiology, nursing, schools, early intervention, business partners and parents/consumers. Over 30 community organizations, and three colleges at OU are involved in IPAC s work Legal Status: 501(c)3 Governance Structure: Independent Board of Directors,15 person; bylaws
Vision of IPAC Our vision is to ensure healthy development for all children in Appalachia Ohio. Mission of IPAC By leveraging our expertise and integrating our resources, IPAC will develop innovative, culturallysensitive programs that address the critical and complex challenges impacting the health and mental health of our region's children and families. Core Value Collaboration & Integration to Improve Quality & Access
Professional Shortages: HPSAs, MHPSAs, Dental Medically Underserved Areas (MUAs) High Poverty High Unemployment Low Educational Attainment
HRSA Net Planning ($85,000): Focused on deciding what being a network would mean, Designed IPACs infrastructure (board, bylaws, legal structure). HRSA Network Development ($540,000): Network self-sustaining Build an integrated health delivery system through interagency collaboration/programs To identify, to refer and to provide comprehensive, coordinator care HSRA Outreach Grant ($375,000): Integration effort expands to MH and Education. Workforce development trauma and autism trainings SAMHSA Project LAUNCH with OH Dept of Health ($4,250,000) Health Promotion Prevention for Young Children accomplished through five young child focused strategies including integrating Behavioral Health and Primary Care; Communication agenda: internal/external communications; branding Regional expansion and workforce development
Linking Actions for the Unmet Needs of Children (birth to eight) Grant partners State Departments with IPAC local implementation identifies barriers to implementation for state partners to address Regionalization. Expands reach for IPAC s regional planning and coordination body to address health challenges through interprofessional, interagency programs
Rural communities Interprofessional teams requires interagency partnerships. Five strategic arms of Project LAUNCH Family Navigator Program & Family Strengthening Early Childhood Mental Health Consultation in Public Preschools Home Visiting/Help Me Grow Developmental Screening and Interdisciplinary Assessment Team Integration of Behavioral Health/Primary Care
Interdisciplinary Assessment Team ECMH Consultation in Preschools Audiologist Speech-Language Pathology MH: Social Work and Psychology Developmental Behavioral Pediatrics Family Navigator Professional Team Development: scope of practice similarities and differences Diagnostics Assessments Ethics Licensing rules, Continuing Prof Development Professions history of consultation Report writing differences Cultures of MH and Education (HIPAA, FERPA; health vs learning) Value added by bringing professionals together success at one leads to success of the other MH into Schools MH is the guest, accommodate to the mission and mandates of education Schools desire MH create receptive space, professional development inc knowledge of EBP Talk through tensions to build shared language, trust and respect Institutions and Professions have cultures
Integrating Professionals for Appalachian Children Interdisciplinary collaboration hinges on interagency cooperation
Mental Health Professionals co-located into Primary Care settings FQHC contractually purchases providers from CMHC University -Affiliated Pediatric Group welcomes two private practitioners Solo for-profit practitioner leases space to CMHC colocates two mh providers in primary care setting Finding the right fit Workforce development Cherokee/IMPACT/UMASS Physically shared space with BH workers
Integrating mental health into primary care dependent on understanding what s in place and building a shared vision. Goals may include: Strengthen identification select foci ADHD, Depression, Development Risk use standardized measures Improving care coordination Ensure patients get to specialty care Ensure information is shared between providers/agencies Improve access and reducing stigma by having mental health providers on site
Screening Patient education/self-management Medication Psychotherapy Coordinated care Clinical monitoring Medication adherence Standardized follow up Formal stepped care Supervision and peer accountability AHRQ Publication No. 09-E003, October 2008
Decrease in no-show rate Reduced ER utilization Reduced Inpatient Admission Improved holistic healthcare Increased ongoing professional development Increased focus on prevention Patient empowerment Real time consultation services Creation of an in-house medical home Adopted from: Cherokee Integrated Health System Training, March 2011
System Efficiencies Scheduling (we ll do it benefits families) Billing (you do it, if no shared fiscal risk) Communication structures not only pass information between providers, it builds trust and cross disciplinary knowledge. Charts and electronic health records (open access? Only shared as needed? Bidirectional?) Advertisement: shared, how described Meetings (administrative, clinical) Curb side consult availability
Adding mental health providers brings wealth of mental health knowledge into the primary care practice. Ahhh but FQHC story Mental health expertise is held primary care docs Managing mh concerns is daily Prescribing psychotropic is daily
Consensus decision making and onsite specialty mental health services. Coordinated decision making and onsite specialty mental health services. Coordinated decision making and off site services OR PCP directed decision making and on-site specialty mental health services. PCP directed decision making and specialty mental health services not provided onsite. AHRQ Publication No. 09-E003, October 2008
Leadership advances the vision shared or not Communication is critical to collaborative care regardless of model Shared language: bridge disciplines Trust: Professional reputation says listen to advice Shared Vision: Algorithms or jointly developed Shared Language Trust Shared vision
Canadian Collaborative MH Initiative Collaborative care is not a fixed model or specific approach; rather, it is a concept that emphasizes the opportunities to strengthen the accessibility and delivery of mental health services through primary health care settings through interdisciplinary collaboration. AHRQ Publication No. 09-E003, October 2008, p. 23
Financial Discipline specific biases Structure: space, policies, procedures Philosophy and Leadership for collaboration The key factor in sustaining is the development of a collaborative culture that values [the team of professionals] as a means to develop and enhance health and social care services as well as the health and well-being of communities. http://www.caipe.org.uk/silo/files/cipw-execsummary.pdf
Work in interdisciplinary teams: Cooperate Communicate Collaborate and, Integrate Care to ensure that care is continuous and reliable. (IOM, 2003) Do we teach these skills? Do our teaching models involves interprofessional teams cooperating, communicating, collaborating and integrating care among diverse health professions and other community professionals?
4 Domains Interprofessional Competencies: Value/Ethics for Interprofessional Practice Roles/Responsibilities for Collaborative Practice Interprofessional Communication Interprofessional Teamwork and Team-based Care (2011, Interprofessional Education Collaborative, Feb 2011 Meeting of IPE Experts, Am Assoc of Colleges of Nursing, AACOM, AACOP, ADEA, AAMC, Assoc of Schools of Public Health)
Work with individual of other professions to maintain a climate of mutual respect and shared values Place the interest of patients and populations at the center of interprofessional health care delivery Recognize and respect the unique cultures, values, roles/responsibilities, and expertise of other health professions. Develop trusting relationship with patient, families and other team members (CIHC, 2010) Maintain own competence (2011, Interprofessional Education Collaborative, Feb 2011 Meeting of IPE Experts, Am Assoc of Colleges of Nursing, AACOM, AACOP, ADEA, AAMC, Assoc of Schools of Public Health)
Use the knowledge of one s own role and the roles of other professions to appropriately assess and address the health care needs of the patients and populations served. Clearly communicate roles/responsibilities to all Engage diverse professionals who complement one s own expertise to develop strategies for patient Communicate to clarify responsibilities Engage in continuous professional and INTERPROFESSIONAL development
Communicate with patients, families, communities and other health professionals in a responsive and responsible manner that supports a team approach to maintaining health and treatment of disease. Listen actively and encourage exchange of ideas across team members Give each other feedback, respond respectfully Use respectful language for difficult situations, crucial conversations or interprofessional conflict Self-awareness Communicate clearly the importance of teamwork
Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable. Describe team development Apply leadership practices that support collaboration Use process improvement strategies to increase the effectiveness of teamwork and team-based care Shift between roles in different situations
What other professions do Develop respect for what others contribute Self-assessment skills Know own strengths and weaknesses Solicit and integrate feedback from others Conflict Management Skills Conflict is inevitable; resolution requires trust, respect, capacity to arrive at consensus Leadership Models that value teams Ability to delineate roles/responsibilities Establishing shared vision, patient-centered processes Understanding of team development and group processes Developmental life cycle of teams/groups Importance of conflict and tension for growth Quality Improvement and process improvement
Development of new curriculum, by interprofessional teams Address professional development of faculty and community preceptors Pursue integrated education across schools of health professions Reinforce constructs through communitybased practice settings, where interprofessional team are working together; exposure to different types of teams
Questions and Discussion Dawn Graham, PhD grahamd@ohio.edu Jane Hamel-Lambert, MBA, PhD Hamel-lj@ohio.edu