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BRIDGING THE GAPRachael Bowers, LICSWNandini Sengupta, MD
April 3, 2013
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WHY INTEGRATE???
Barriers to Access Behavioral Health Services
Financial Concerns
July 2011: Launch Behavioral Health Pediatric Integrated Program (BHPIP)
January 2012: Complete integration of all Pediatric BH Services into BHPIP
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OUR MODEL – WHO WE ARE
5 Primary
Care Providers
1
Pediatric Social
Worker
3 Licensed
Behavioral Health
Clinicians
1Child
Psychiatrist(1
day/week)
3,000 PatientsBH served 221 Patients (7%)
3,784 Encounters
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OUR MODEL – WHAT WE DO
Individual and Family Therapy
Psychiatry (weekly)
School-Based Behavioral Health Services
Consultation to PCPs during medical appointments
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OUR MODEL – HOW WE DO IT
Strong Clinic Leadership Commitment to Integrate
Co-location Warm Hand Off Pediatric Social Worker Shared EMR Shared Administrative Staff Primary Care Behavioral Health
Consultation Training Creative Access to Child Psychiatry
Services
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CO-LOCATION
Fall 2013: Rate of referral = 16/month
CONSTRUCTIONBHPIP Moves across the hall at the
end of November
Rate of referral DROPS to 8.5/month
Seasonal Variation? Not entirely: Winter 2012 ROR 13/month
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WARM HAND-OFF
Tracking began July 1, 2013
Intakes Completed
With Warm Hand-off69%
Without Warm Hand-off25%
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WARM HAND-OFF
CONSTRUCTION
July - November 2013: WH rate 53%
December 2013 – February 2014: WH rate 21%
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BRIDGING THE GAP
Intake
Clinician
“Translator”
Referral Coordinator
Liaison
Pediatric Social Worker
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OUTCOMES I - ACCESS
Referrals to BH at Dimock increased from 18% to 63%
Wait time for Services reduced to 1-2 weeks
Why refer to other agencies? 1. Language Needs 2. Preference for School Based Services at a School
Dimock does not serve 3. Preference for Home-Based Services 4. Distance
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OUTCOMES II - QUALITY OF CARE
COMPLIANCE WITH INTAKE: 67% Rough estimate of compliance pre-integration: ~30%
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OUTCOMES III – FINANCIAL SUSTAINABILITY
Cost Neutral by the end of second Fiscal Year
More streamlined/efficient use of Employee Time
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OUTCOMES IV - MORALE 1. Mutual Respect of Providers’ Disciplines
2. Frequency and Quality of CommunicationLeading to better understanding of
patients (both MD and BH) and better compliance and tracking of patients within BH services
3. Improved Access to Services and Access to Information about Treatment (for MD)
4. Role of SW to facilitate the process from both MD and BH perspectives
5. Feeling of support and efficacy in role (BH)
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EXPANSION
OBHI(Ob/Gyn and Behavioral Health
Integration)Launched November 1, 2013
Funded by Children’s Hospital
1.Introduction of BH services at New OB appointment2.MH Screening at prenatal and post-partum appointments3.Access to BHPIP for services when needed or requested
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WHERE NEXT?
Behavioral Health Consultations
1. Increase: Could we reach more than 7% of Pedi patients?
2. Billing???
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WHERE NEXT?
Could we integrate care of chronic conditions?
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WHERE NEXT?
How do we redefine the “closed” BH case?