Department of Behavioral Health and Intellectual disAbility Services

June 25, 2013

Eleventh Street Family Health Center0f Drexel University

Patricia Gerrity, RN PhD, FAAN

B

Community Partnership

• Started 1996

• Residents of four public housing developments in Lower North Philadelphia

• Community Driven

• Had to develop trust

• Community was tired of being assessed and surveyed

Just cause you’ve got the recipe doesn’t mean you’ve got the cake

“Man is the only animal that cries because man alone sees the difference between what is and what could be”

Victor Hugo

In partnership with the Family & Practice & Counseling Network

11th Street Family Health Services of Drexel University

Development Based on NeedsPopulation Focused

Original Study vs 11th St ResultsNumber of

Adverse Childhood Experiences (ACE Score) Women Men Total

11th Street Patients

Original Study

11th Street Patients Original

Study11th Street

Patients Original Study

0 6.8% 34.5% 3.9% 38.0% 6.3% 36.1%

1 12.5% 24.5% 9.9% 27.9% 12.0% 26.0%

2 18.5% 15.5% 14.5% 16.4% 17.8% 15.9%

3 14.6% 10.3% 16.4% 8.6% 14.9% 9.5%

4 or more 47.5% 15.2% 55.3% 9.2% 49.0% 12.5%

Integrative Health Care

To create a seamless engagement by patients and caregivers of the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health throughout the lifespan.

Primary Care Redesign

• More than adding services to primary care, or simply adding traditional mental health philosophies, skills & interventions in a new setting

• Requires systems redesign• Providers shift from independent clinician to a

functioning team member• Each member of the team must understand

enough about the discipline & training of team members to communicate effectively and to design collaborative interventions that will meet the needs of the patient.

Every great change must expect opposition because it shakes the

very foundation of privelege.

Lucretia Mott

Integrated Team• Family nurse practitioner• Clinical nurse• Primary behavioral health consultant

– Child & adult– Couples & Family Therapist

• Generalist social worker• Health educator• Nutritionist• Complementary & integrated therapist• Physical therapist• Fitness trainer• Nurse family partnership home visitors• Creative arts therapists• Attorneys

Characteristics of Integrated care

• High degree of collaboration and communication

• Establish comprehensive treatment plan to address biological, psychological and social needs of patients

Shared Language

• Project LEAP- Learning through Effective Ambulatory Practices

• Integrated care• Complementary & integrative therapist• Architects- engagement room (ER)

Lexicon for Behavioral Health & Primary Care

• Peek CJ and the National Integration Academy Council

AHRQ Pub No 13-IPOOO1-EF

What is it?

• The care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systemic and cost effective approach to provide patient centered care for a defined population.

The care may address

• Mental health conditions• Substance abuse• Health behaviors• Life stressors and crises• Stress related physical symptoms• Ineffective patterns of health care utilization

How

• A practice team tailored to the needs of each patient and situation

• With a shared population and mission• Using a systematic clinical approach ( and a

system that allows the clinical approach to function)

Supported by

• A community, population, or individual expecting that behavioral health and primary care will be integrated as a standard of care

• Supported by office practice, leadership alignment, and business model

• Continuous improvement and measurement of effectiveness

All Services at 11th Street FHS

Primary Care

Microsystems

• A small interdependent team defined at the level of each patient that forms to meet particular patient and family needs

• The microsystem changes as the needs of the patient and family shift

Creative Arts Therapies

Creative Arts Therapies (CATs) are the psychotherapeutic use of movement/dance, music and art to further the emotional, cognitive, physical and social integration of the individual. CATs are behavioral health therapists who integrate evidence from fields like neuroscience, human development and behavior, counseling, psychopathology and multiculturalism to develop their practice of assessment and treatment. Both individual and group therapy is provided. CATS serve as primary counselors for our patients, and treat in conjunction with talk therapists, physical therapists, nurse practitioners and the nutritionist, for example.

Social Work

Pharmacy

Dental

Physical Therapy

Health Education Outreach

Behavioral Health, FPCNLicensed social workers, psychologists and psychiatrists offer diagnostic assessments; psychiatry services including medication evaluation and management; short-term or long-term individual talk therapy for adults and talk and play therapy for families, children (ages 4 and up) and adolescents.

Behavioral Health Programs

• Co-located outpatient behavioral health• BHC Adult

– ESBIRT– Trauma

• BHC children & families• Creative arts therapy• Complimentary therapies

o MBSRo Yogao Mediation

• Chronic pain- Power Over Pain• Intensive Care Management

Adult BHC

SBIRT

• Screening, Brief Intervention, & Referral to Treatment

• Collaboration with the Treatment Research Institute

SBIRT

• Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.

• Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.

• Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.

Power Over Pain• Chronic Pain Resource Center• You are worth more than your pain!

Empower yourself to be well!

Goals:• Learn how to live with chronic pain. • Managing the different aspects of pain experience. • Create a safe and open learning environment where

there is no judgment. • To empower patients to manage their own pain when

they are at home doing the things they want to do.

Power Over Pain

• Clinical nurse• Behavioral health consultant• Physical therapist• Complimentary & integrative therapist• Creative arts therapists• Dance /movement

The Goals of The Porch Light Initiative

Shed light on challenges faced by those with behavioral health issues, reducing stigma and encouraging empathy among fellow community members

Create a network of services for the benefit of individuals and families that heightens awareness of behavioral health resources and increases access to treatment

Build a team of artists, service providers, individual participants, and other stakeholders that collaborate on transformative public art projects which encourage community ownership and pride and catalyze positive changes in neighborhoods

Adult BHC• Monitoring and supporting people with

chronic physical illnesses

• Care management for depression or other behavioral conditions

• Skills in patient activation, goal setting, motivational interviewing and fostering health behavior change.

• SBIRT- Treatment Research Institute

Dance Movement Therapy with Lindsay Meeks

Fitness Center

Yoga with Kathleen Guidotti

Pediatric Team

• Behavioral health consultant PsyD• Family & child supports coordinator• Family Nurse Practioner• Midwife

• Resilience

Pediatric BHC

Centering Model

• Incorporation of – Assessment – Education– Support

• Provided by an interdisciplinary team in a group setting

Visit for Mother and Baby

Centering Parenting

• Babies grouped by age• Care for mom and baby

in same visit• 6-8 parent-baby dyads

per group • 2 hours with

practitioners• Focus on development,

safety, nutrition, family

Helps establish a foundation for supporting healthy family behaviors and promoting mental health

Learn Normal Development

Relationship Based Practice

Results in early identification of developmental, behavioral and health problems – can receive early intervention

Building Agency Capacity in Program Evaluation

Funded by:

Scattergood Behavioral Health Foundation

Consultation provided by:

Yale School of MedicineConsultation Center

Building Agency Capacity • Focused on Evaluating Centering Program

– Well-child program in both group and individual sessions– Multifaceted role of the PBHC within this program

addressing the emotional, mental, and behavioral health of mothers and their children.

– Skills gained will be used to develop and assess other programs at the center

Scattergood Project

Patient Centered Wellness Tracker

Screenings used to focus visits and collect data.

Mean % Difference Sig. (2-tailed)

Physical Functioning 6.25% 0.38

Role Physical 11.40% 0.232

Bodily Pain 6.70% 0.362

General Health 4.40% 0.51

Vitality 12.05% 0.06 *

Social Functioning 17.40% 0.016 **

Role Emotional 8.03% 0.438

Mental Health 18.60% 0.001 **

Physical Health Component Score 1.20% 0.687

Mental Health Component Score 8.70% 0.013 *

Scores from the SF-36 and GAD-7 after completion of the MBSR Program

** = highly significant improvements* = significant improvements

Mean % Difference Sig. (2-tailed)

GAD-7 11.07% 0.042 *

Challenges

• Space • Time for team meetings• Reimbursement- centered on primary care

clinical encounter, if no DSM diagnosis• Lack of shared care plan

Next Steps

• Health services researcher to join team in October

• Develop comprehensive screener and visual report form on PCWT

• All new patients seen first by BHC, review screening and help plan individualized care

• PAM, GAD7, PHQ9, ACEs, SBIRT, SF36