memphis vamc robert baldwin, ph.d. charissa camp, ph.d. november 1, 2012 presentation for tpa...
TRANSCRIPT
Memphis VAMC
Robert Baldwin, Ph.D.
Charissa Camp, Ph.D.
November 1, 2012
Presentation for TPA Convention 2012
Primary Care Psychology &the Behavioral Health Lab
Dr. Oslin and Philadelphia VA“Best Practice”Evidence and Readings Handout
Background
Memphis Main Hospital CampusCo-Located Collaborative Care and Care
Management StaffCopper Behavioral Health (PC-MHI Psychologist Dr.
Robert Baldwin)Blue Behavioral Health (PC-MHI Psychologist Dr.
Charissa Camp)
Louisville Call CenterBHL Care Management Staff
Program Director (Psychologist Dr. Beth Scheu)2 RNs1 Supervisory Health Technician12 Health Technicians
Personnel
Veteran CenteredPrimary Care Patient Aligned Care Team
VeteranPCPRNClinical AssociateClerical Associate
Auxiliary PACT MembersPsychologist <-> BHLNutritionistSocial Worker
The PACT Model
Psychologist = CCCCCC = Co-located collaborative care
BHL = CMBHL = Behavioral Health LabCM = Care Management
PC-MHI = CCC + CMPC-MHI = Primary Care Mental Health
Integration
Fun with Acronyms (the VA way)
Disease Management (Brief Counseling)Depression Monitoring (BHL)Watchful Waiting (BHL)Referral Management (to MH, SA, PCT, SMI,
other)SMI ManagementNo Tx—Refusal of services/Not in need of
services
The Six Dispositions that follow CORE
PC-MHI/BHL Clinical ProcessPatient Identification
By screening or clinical assessment in PCC
BHL Core Assessment
Referral Management
to MH, SA, PCT, &/or
SMI services
Review Results + Triage (by PC-MHI Psychologist)
Disease Management and/or
Medical Consultation
No Treatment Indicated Refusal of Services
BHL Watchful Waiting or
Depression Monitoring
** Initial PC-MHI Psychologist Contact
** when possible
Warm-HandoffWhen pt is identified by PCP or self-identifies
as having an urgent MH issuePCC staff contacts Psychologist (individual
teams have different methods of communication)Pt is seen same-day, generally within 30 min or less
due to protected scheduleInitial contact note is completed and initial triage
madeCORE is scheduled to start parallel care
management services (CORE if appropriate)
In case of emergency…Access/Warm-Handoffs
Structured Interview completed by HTsScreening assessment
-Depression - Anxiety and Panic-Trauma - Mania-Psychosis - Substance Abuse-Cognitive Impairment
Report summary generated for CPRSReviewed and disposition made by the
appropriate PC-MHI Psychologist, depending upon clinic—Copper or Blue
Core Report
Initial Referral Primary Care Staff refer to PC-MHI Psychologist via route agreed
upon by that clinic (consults, additional signers, whatever) Referral for BHL support
PC-MHI Psychologist sends basic info to a sharepoint to enroll Veteran in BHL for Core Assessment
Same day Assessment/Evaluation If emergency or positive clinical reminders
Triage and Referral Determine the recommended and Veteran directed level of care –
refer as indicated (back to BHL or to specialty MH services) Brief Therapy
Typically 1-6, 30 min visits Goal directed/action oriented/MI or SMI management
Referral Management Motivational interviewing is utilized to assist Veteran in referral
process to specialty care such as MHC, PTSD, CDC, SMI programs
Now let’s review CCC and CM and then specifics of dispositions…
Co-located Collaborative Care (CCC)
Health Technicians (HTs) in LouisvilleConduct the BHL phone services (structured
interviews at intervals determined by protocol and/or clinical recommendation)
PC-MHI Psychologists (also the CCC provider in the Veteran’s Primary Care ClinicReviews all collected data and drafts of CORE
reports edits them in CPRS with a dispositionCommunicates with PC medical providers via
CPRS or in person about dispositions and status of Veteran’s mental health issues
Care Management (CM)
Brief Therapy (1-6 sessions)Cognitive BehavioralSolution FocusedMotivational Interviewing Use of Action Plans
Often concurrent with Depression Monitoring when the patent is placed on an Antidepressant by their PCP
Lose the couch and (maybe) the do not disturb sign
The Dispositions:
Disease Management (Brief Counseling/Brief Interventions)
PCP prescribed new Antidepressant per MH-PC service
agreementSignificant changes in their Antidepressant
Phone calls at week 2, 6, 9, by Health Techs to administer follow-up screenersPHQ-9, Sub Abuse
If PCP is not comfortable prescribing necessary medication, patient is placed in Referral Management to psychiatry
Depression Monitoring (DM)
HT will alert psychologist that contact has been completedPsychologist will review report, make edits, make
treatment adjustments, and place the report in CPRSIf trend is static or depressive symptoms increase,
psychologist contacts Veteran for phone contact/assessment or have their Prescribing Provider consultant look at case and make recommendations for PCP or PCP may refer to psychiatrist
Final Depression Monitoring report, paste into CPRS with determinationOften the psychologist will contact the Veteran to confirm
determination is consistent with pt needs/desiresClosing summary note is completed if appropriate
CM/BHL for Depression Monitoring
Mild cases of mental health symptomsPatients not willing/able to engage in
treatment
8 weekly phone calls: Health Techs will call to complete follow-up screeningPHQ-9, Sub Abuse
If conditions worsen, can be referred for disease management or referral management
Watchful Waiting (WW)
HT will alert psychologist of the completion of this contact (often with encrypted email as well)
Psychologist logs into BHL software to review trend in PHQ-9 scores and substance abuse report
If trend is static or depressive symptoms/SA increases, psychologist contacts Veteran for phone contact/assessment
Final WW will elicit a BHL software report; access and edit similar to Core and paste into CPRS with determinationOften the psychologist will contact the Veteran to
confirm determination is consistent with pt needs/desiresClosing summary note is completed if appropriate
CM for Watchful Waiting
Facilitate transition between Primary Care and Specialty Mental Health ServicesOffer interim appts/contacts as needed
VA system consults to specialty services as indicated
If high risk, psychologist will follow-up by phone or in person during interim and coordinate with Suicide Prevention Team as needed
Referral Management (RM)
May or may not have COREMonthly supportive meetings for persons with
serious mental illness that are not appropriate for other categories
SMI Management
(a) Referral from PACT to PC-MHI Psychologist(b) CORE/Initial meeting with psychologist(c) Review of CORE and determine
disposition(s) (6 possible)(d) Follow procedure for disposition(s) selected(e) Close
As with PCP, Veteran/patient may be seen again in future as primary care psychology need arises.
Let’s Review the Steps
