Bridging the gap

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Bridging the gap

• Rachael Bowers, LICSW
• Nandini 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 1 Child Psychiatrist (1 day/week)
3,000 Patients BH served 221 Patients (7) 3,784 Encounters 3,000 Patients BH served 221 Patients (7) 3,784 Encounters 3,000 Patients BH served 221 Patients (7) 3,784 Encounters 3,000 Patients BH 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
• CONSTRUCTION
• BHPIP 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 Intakes Completed
With Warm Hand-off 69 Without Warm Hand-off 25
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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
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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 Communication
• Leading 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 Childrens Hospital
• Introduction of BH services at New OB appointment
• MH Screening at prenatal and post-partum
  appointments
• 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?