connecting primary care and specialty mental health: moving from competition to collaboration
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Connecting Primary Care and Specialty Mental Health: Moving from Competition to Collaboration. Cynthia Cartwright, MT RN MSEd Melissa Cormier, LCSW Mary Jean Mork, LCSW October 11, 2013 CFHA Session G1b. - PowerPoint PPT PresentationTRANSCRIPT
Connecting Primary Care and Specialty Mental Health:
Moving from Competition to Collaboration
Cynthia Cartwright, MT RN MSEdMelissa Cormier, LCSWMary Jean Mork, LCSWOctober 11, 2013CFHA Session G1b
…Or, acknowledging our different lenses and planning to bring it all
into a shared focus.
Workshop Outline
Description of present culture rift (10 min) Identification of potential strategies to reduce
rift at all levels (10 min) Activity (10 min) Planning for your next steps (10 min)
Learning Objectives:
Attendees will be able to: Identify the cultural and organizational differences
that influence the present mistrust between health care providers and mental healthcare providers
Develop strategies to target and reduce the culture rift at all levels: from leadership to the individual practitioners
Who are we?
Maine - Where we live and work.
On a bad day….…connection between primary care
and mental health looks like….
On a good day……connection looks like…
What do you need to look at differently?
Connecting at all levels
Leadership
Practice/Program
People
Leadership Challenges
Financial – history of “carve-out’s” and separate budgets
Different rules and regulations Competing priorities Turf
Leadership Strategies
Look for linkages – e.g. ACO development, Health Homes Foster champions and change agents Maximize connecting opportunities - locally and
regionally Support emerging leaders Communicate respectfully and often Appreciate competing demands, but also where linkage
becomes important Build relationships
Practice Level Culture Clash
Primary Care Mental Health
Pace 15 minute appointment 50 minute sessions
Setting Exam room Office
Language “Patient”
Diagnosis, medical terminology, complaints
“Client”
Assessment, mental health terminology, issues
Hierarchy Clear – Dr. in charge Diffuse – Administrator in charge with med director
Flow Flexible patient flow Scheduled client flow
Focus Specific focus on presenting problem
Traditional comprehensive approach to treatment
Documentation Brief, SOAP structured Progress and process recording, Comprehensive
Privacy of Info HIPPA Rights of recipients,
42 CFR part 2, etc.
Finances Medical bill Prior authorization, mental health carve-outs
Mental Health & Primary Care Differences
What did we learn?
There’s concern about time to talk No emphasis on meeting in person Desire by both to have a “working relationship” Communication is key Patients/clients are not a barrier
Practice/Program Strategies
Set up targets for improved access Clarify expectations and aim for timely
communication Set up regular meetings Promote the use of standardized screening &
assessment Increase use of technology Build relationships
Strategies for Mental Health Programs
Client/PatientIdentify Health Status and PCP coverageIncrease the number of clients with a PCPInclude Releases of Information to PCP’s as part of intakeAssist clients in using primary carePracticeEducate PCP’s about mental health problemsEstablish process to routinely coordinate careEstablish method to identify clients at high riskCreate process for collaborative planning for high risk populationsBuild relationships
People Challenges
Attitudes and experience Struggles with communication Personalities Competing demands Geographic separation Turf
People Strategies
“No wrong door” Collaborative learning
– Teams and disciplines come together– Introductions and ongoing informal connecting
Offer site visits, conference calls, Webinars Be responsive Foster relationships/communication
Connecting at all Levels Leadership: The right culture - an agency-wide culture shift is
necessary to make these changes. Business as usual will hamper integration.
Practice: The right training - provide staff the tools and knowledge to work within an integrated health program.
People: The right people - all staff, down to the front office, must understand the importance of integrated services and why the agency provides these services.
From the SAMSHA-HRSA Center for Integrated Health Solutions
Tips for Connecting
Build and nurture relationships Focus on communication and coordination Clarify Roles Establish shared goals
Lessons LearnedLeadershipBe aware of organizational power and politicsMoney matters
Practice/ProgramAcknowledge when turf is being challenged, or protectedPause to look at the big picture, and remind others to do so
PeopleExpect variability; some people will see the larger picture, others will notPatients/clients and families are valuable teachers in the collaborative process
Lessons Learned – at all levels Everything takes much more time than you thought it would
(or should)! Foster linkages and relationships and sustain them Be willing to work at many levels at the same time There will be blind spots. Watch for them. Grab all opportunities: even the smallest steps can create
positive change Be open to what is not working and why: be prepared to
make significant changes in perception and direction
Tools for Connecting at the Practice Level
Readiness survey: for primary care and Readiness Survey with Change ideas
AIMS Center “Staff Self-assessment”: from the IBHP Partners in Health Interagency Toolkit
Tips: for Connecting Primary Care and Behavioral Health Organizations
Activity
What can you do to make improvements in the connection, and how will you start this process?
What are you willing to commit to doing when you get back to work?
Resources www.thenationalcouncil.org – the National Council for
Community Behavioral Healthcare www.ibhp.org – Integrated Behavioral Health Project www.mainehealth.org/mentalhealthintegration
Contact Information
Cynthia Cartwright, MT RN MSEd [email protected]
Melissa Cormier, LCSW [email protected]
Mary Jean Mork, LCSW [email protected]
