Transcript Integrated Behaviora.. - Access Florida Tech

The Integrated
Behavioral Health Service
Tiffany Cummings, M.S., Natasha Mroczek, M.S., &
Thom Harrell, Ph.D.
School of Psychology
Florida Institute of Technology
Objectives of the Presentation
• Explain the Integrated Behavioral Health Service
Model and how if differs from traditional/specialty
Mental Health care
• Clarify the scope of service of the Behavioral Health
Consultant
• Describe the benefits of integrating Behavioral
Health Consultants (BHCs) with primary care medical
providers
What is an Integrated Behavioral Health
Service?
• Service provided by a psychologist, who is working as a
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Behavioral Health Consultant (BHC) to the patient and to the
medical care team
Patients are seen for health behavior change and health
management as well as psychiatric symptoms
BHCs are available immediately during working hours, so they are able to see
patients same day in most cases
Patients are typically seen for 30-45 minutes on initial referral
Initial contact includes assessment and initial treatment recommendations to
patient, and feedback to physician
Follow-up contacts are typically 20-30 minutes, and can be linked to medical visits
Most patients are seen for 3-5 visits. When more extensive intervention is
required, patients are referred to traditional mental health services
Reasons for Referrals
• Chronic Medical Conditions
 Diabetes, hyperlipidemia, hypertension,
cancer, chronic pain, RA, IBS, fibromyalgia, etc.
• Physical problems with a behavioral
component
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Obesity, insomnia, chronic headaches, etc.
• Prevention
 Smoking cessation, diet/exercise change
• Difficult patient interactions/behaviors
 High resource users, disruptive patients, patients
who are noncompliant with medical treatment
Reasons for Referral
• Psychiatric Disorders
 Mood Disorders, Anxiety, Personality
Disorders, Psychoses
• Substance Use Disorders
• ETOH, Narcotics
• Sub-threshold Conditions
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Bereavement, relationship problems impacting health, stress,
domestic violence/abuse
• Suicidal concerns
Reasons for Pediatric Referrals
Childhood obesity
 Chronic somatic complaints
 Behavior problems
• ADHD
• Social skills training
• Parenting skills training
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Why integrate behavioral health and
primary care?
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Only 20% of all patients referred to external mental health providers
complete the referral
67% of all psychotrophic medications are now prescribed by primary care
physicians
80% of all antidepressant medications are now prescribed by primary
care physicians
Chronic medical conditions are the fastest growing area of primary care,
but 60% of all patients with chronic conditions do not fully adhere to
medical recommendations
Behavioral Health Service Concepts
• Consultation model is designed to
respond to the physician’s specific referral
question or concern
• Behavioral Health Consultant role is brief
and focused, as opposed to traditional
mental health provider service delivery
• Behavioral Health Consultant is available
to physicians and patients (on referral) for
immediate consultation
Referral Process
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Physician may briefly consult with BHC prior to referral,
or simply have nurse check on BHC availability.
Physician notes referral and reason for referral in
patient’s medical chart.
BHC will see patient immediately if available or later the
same day if wait is not too long. Otherwise an
appointment with the BHC will be scheduled.
BHC completes a contact note in patient’s chart and
gives verbal feedback to physician if requested.
BHC will coordinate immediately with physician to
address any emergency situations.
Explaining Referral to the Patient
Sample Introduction Scripts:
Example 1: It sounds like you might be having a lot of
stress right now. I work with someone who
specializes in helping with these issues, and I
would like you to speak with them today to better
help me help you. Is it alright with you if I
introduce you to her/him?
Example 2: It’s really important that you better
manage your weight. I have a colleague who can
give you some specific ideas about how to do this.
Her/His office is just down the hall. My nurse will
walk you there after we’re done.
It’s best not to use the terms therapist, counselor,
or psychologist when referring. We use the title
Behavioral Health Consultant because it doesn’t
have any stigma or connotations.
Behavioral Health Service
Intervention Overview
Immediate, prn consultation to
physicians on any patient-related matter
 Brief assessment of patients with
findings and treatment plan documented
in patient’s medical chart
 Patient education / written plans and
guidelines for change / handouts
 Home-based patient practice or
engagement in new behavior
• Coordinate intervention with case
management as needed
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Termination & Follow-Up
• Physician notified of status via
contact notes in patient’s chart
• BHC may provide planned booster
sessions for at-risk patients via 3month clinic appointments or
telephone appts.
Florida Tech BHC Program Implementation
• Advanced Clinical Psychology Doctoral Students serve
as primary on-site Behavioral Health Consultants.
• A FL Licensed Clinical Psychologist serves as clinical
supervisor. Supervisor is available to students at all
times they are in the clinic via phone.
• We will conduct an ongoing evaluation of service
delivery and outcomes, and we encourage your
feedback at any point in time.