Telligen Quality Innovation Network – Quality Improvement Organization Behavioral Health Recovery: Leveraging Outside Resources and Addressing Patient and Family Stigma Wednesday, May 1, 2019 This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, 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. This material is for informational purposes only and does not constitute medical advice; it is not intended to be a substitute for professional medical advice, diagnosis or treatment. . 11SOW-QIN-C3-02/19/19-3244
Telligen QIN-QIO 2
Join the Telligen QIN-QIO Network The Telligen QIN-QIO network offers expertise and support at local, regional and national levels We believe the quality of healthcare can be transformed to better serve the people of all communities How we serve our participants: • Assess and understand unique needs and opportunities • Provide opportunities to connect with • Align improvement efforts • Leverage expertise and relationships • Facilitate connections, sharing and learning • Bring you access to tools, resource, metrics, evidence based, collaboration, best practice, peer support, education 3
Behavioral Health Recovery: Leveraging Outside Resources and Addressing Patient and Family Stigma Presenter: Megan Swenson, MA LPC LAC Manager of Integrated Care and Care Coordination
Jefferson Center A Community Mental Health Center Our mission: To inspire hope, improve lives and strengthen our community by providing mental health and related solutions for individuals and families. Our values: People First • Empathy with excellence • Collaborate to make life better Community minded • Anticipate and evolve • Dignity for all Jefferson Center is a nonprofit, community-focused mental health care and substance use services provider. We offer hope and support to individuals and families who are struggling with mental health issues and substance use disorders. Serving our community is at the core of everything we do.
Integrated Care and Care Coordination Breaking the silos of behavioral health care and medical care to address the whole patient Behavioral Health Recovery What it looks like in medical settings HOPE HOME COMMUNITY PURPOSE HEALTH
Integrated Care and Care Coordination Breaking the silos of behavioral health care and medical care to address the whole patient Behavioral Health Recovery What it looks like in medical settings HOPE HOME COMMUNITY PURPOSE HEALTH
SAMHSA Levels of Integrated Care Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013
Social Service Agencies Specialty Clinics Hospitals Primary Care Clinics Hospitals Primary Specialty Care Clinics Clinics Dental Clinics Housing Providers Graphic courtesy of Dale Jarvis & Associates
Union Square Health Home (USHH) Space includes: 9 exam rooms and a procedure room • Jefferson Center Outpatient/Intensive/ACT/Navigation/Wellness/ • Supported Employment/POD
Jefferson Plaza Family Health Home Jefferson Plaza is a family health home shared with MCPN that includes medical providers specializing in youth, families and adults and a pediatric NP, a midwife, and an adult PA. Space includes: 10 MCPN exam rooms, 10 Jefferson Center offices, and 2 consult rooms
Integrated Care and Care Coordination Breaking the silos of behavioral health care and medical care to address the whole patient Behavioral Health Recovery What it looks like in medical settings HOPE HOME COMMUNITY PURPOSE HEALTH
Terminology Review Behavioral Health : Behavioral health looks at a persons emotions, behaviors and biology and associates these areas to an individuals mental well-being, their ability to function in every day life, and their concept of self. Behavioral health not only looks at mental health and wellness but also an individual’s possible substance use and abuse and overall recovery. Recovery: A process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations (SAMHSA).
Myths and Misconceptions Patients with MH or MAT replaces one Inpatient treatment is SUD are “difficult” addiction with another always necessary Relapse = ineffective tx Behavioral Health Abstinence is the only and/or moral failing prevention doesn't work way to be in recovery Addiction is a choice, not Personality weakness/ People with mental health a disease; they can stop can’t hold down a job character flaws cause MH if they wanted to
Relationship “The focus groups revealed that the patient-provider relationship is the “single most important hallmark of quality care,” the report stated. Finding a provider who meets individual patient needs is part of building a quality provider relationship .” https://patientengagementhit.com/news/cons umers-say-patient-provider-relationship-key-to- quality-care
Integrated Care and Care Coordination Breaking the silos of behavioral health care and medical care to address the whole patient Behavioral Health Recovery What it looks like in medical settings HOPE HOME COMMUNITY PURPOSE HEALTH
Hope , the belief that these challenges and conditions (behavioral health) can be overcome, is the foundation of recovery. A person’s recovery is built on his or her strengths, talents, coping abilities, resources, and inherent values. It is holistic, addresses the whole person and their community, and is supported by peers, friends, and family members. - SAMHSA
Hold slide for Sonja’s story
SAMHSA: Recovery Support Strategic Initiative (https://www.samhsa.gov/recovery) (2016) Health –overcoming or managing one’s disease(s) or symptoms, healthy choices for physical and emotional well-being Home – having a stable and safe place to live Purpose – meaningful daily activities such as a job, volunteerism, family caretaking to participate in society Community – relationships and social networks that provide support, friendship, love, and hope
Integrated Care and Care Coordination Breaking the silos of behavioral health care and medical care to address the whole patient Behavioral Health Recovery What it looks like in medical settings HOPE HOME COMMUNITY PURPOSE HEALTH
Universal Behavioral Health Screening in Medical Settings
Adverse Childhood Experiences (ACE) Survey Collected one time: -Adult patients -Adolescent patients 13 yrs+ -Parents of patients under 13 yrs Use of original ACE questionnaire; expanded using Center for Youth Wellness ACEQ- includes foster care, bullying, intimate partner violence, deportation, etc. Psychoeducation about trauma, resiliency and community resources are reviewed after each interview.
ACE score of 4+ decreases life expectancy by 20 years. Content source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention https://www.cdc.gov/violenceprevention/acestudy/ACE_graphics.html
ACE Score > 3 • 1.5x the rate of obesity • 6.5x the rate of ever having a suicide attempt • 5x the rate of self reported Alcohol Dependence • 7x the risk of ever having injected drugs • 1.5 x as likely to have Ischemic Heart Disease • 1.3 x as likely to have a stroke • 2 x as likely to have COPD • 1.2 x as likely to have Diabetes • 1.2 x as likely to have a fracture Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults Felitti, Vincent J et al. American Journal of Preventive Medicine , Volume 14 , Issue 4 , 245 - 258
SBIRT screening Follow up screening tools: 1. AUDIT (alcohol use) 2. DAST (drug use) 3. PHQ9 (depression) 4. GAD7 (anxiety) 5. Nicotine use/smoking cessation
Social Determinants of Health (Heiman & Artiga, 2015) Economic Stability – Employment, Income, Expenses, Debt, Medical bills Neighborhood and Physical Environment – Housing, Transportation, Safety, Parks, Playgrounds Walkability Education – Literacy, Language, ECE, Vocational training, Higher education Food – Hunger, Access to healthy options Community and Social Context – Social integration, Support systems, Community engagement, Discrimination Health Care System – Health coverage, Provider availability, Provider linguistic & cultural appropriateness, Quality only addresses 20% of a persons health and well-being
Why is it important to address social determinants of health?
https://www.promedica.org/socialdeterminants/pages/default.aspx
Screening for Social Determinants of Health and Recovery Supports Questions: 1. Are you already screening? 2. If not, why not?
The Denver Regional Accountable Health Community
Weekly Multidisciplinary Care Team Meeting • Takes a “whole person” approach • Includes Primary Care Provider, Medical Assistants, Psychiatrists, Therapists, Care Coordinators (Nurse or Therapist), Health/Wellness Coach, Navigation • Shared “Collaborative Care Plan”
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