Integrating Mental Health into the Medical Home

May 2011

Portland Family Practice

Aim

Improve screening, identification, and treatment referral for adult and adolescent patients who are high risk for substance abuse and depression

Objectives

Hire mental health professional for expertise and assistance with program development

Integrate mental health professional into existing family practice model

Identify patients who are at risk for depression & substance abuse; assess co-morbidity

Provide mental health services directly or refer to appropriate outside providers

Hiring for the right fit

Hired licensed psychologist, Pat Blumenthal, PsyD

Experience in providing individual & family therapy Experience with using screening tools and collection

of outcome data Experience with managed care and insurance Experience in program development

Teamwork

Coordinated efforts with: Information Technology Physicians & Medical Assts Intake/Triage Case managers in Medical

Home Front Office staff Schedulers Billing & Benefits

Reporting

Coordinationof Services

Training

Referrals

IT WorkflowSet up

Mental Health

Objectives & Measures

All patients given the PHQ-9; teens given additional CRAFFT

Scores documented in medical record

Scores above threshold identified for mental health referral

PHQ-9 Questions

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling or staying asleep, or sleeping too much

4. Feeling tired or having little energy

5. Poor appetite or overeating6. Feeling bad about yourself—or

that you are a failure or have let yourself or your family down

7. Trouble concentrating on things, such as reading the newspaper or watching television

8. Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead, or of hurting yourself in some way

CRAFFT Questions

• C—Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?

• R—Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?

• A—Do you ever use alcohol/drugs while you are by yourself, ALONE?

• F—Do you ever FORGET things you did while using alcohol or drugs?

• F—Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

• T—Have you gotten into TROUBLE while you were using alcohol or drugs?

Visibility

Methods of Promoting Awareness of Mental Health Services

Screening tools given to patientsDialogue between PCP – Patient about mental

health issuesPosters in all exam roomsWebsite presence with Mental Health blog “Curbside Counseling”, seamless introductions

Mental Health Services

PCPs give patient recommendation for counseling based on score.

For many patients, PCP offers chance to meet Dr. Blumenthal to make initial contact or to schedule appointment before leaving office.

If unable to meet initially, Dr. Blumenthal contacts the patient by phone to offer services.

PHQ-9 Results

Adult PHQ-9 Results

8%n = 269

91%n=3001

1% n=20

PHQ-9 POS Adults

PHQ-9 POS Adol

Negative Results

89%n=82

11% n=11

Positive Results

Negative Results

CRAFFT Results

Lessons Learned

• Hiring

• Credentialing & Insurance Issues

• Training & workflow

• Provider Involvement

• Confidentiality

• IT challenges

• CRAFFT (parents)

• Consistency

Identification & Referral underway

• In-house treatment• Phone outreach• Tracking• Referrals• Re-test

Success Stories

59 year old breast cancer patient

52 year old female with recent suicide attempt

28 year old male, unable to work

• Follow up - Therapy outcomes

• Utilization patterns

• Continued outreach

Next Steps

Project Team

• Bunny Meharry, RN, BA– Clinical Operations Manager

• Cindi Bourn– MA/IT EHR Manager

• Pat Blumenthal, PsyD– Clinical Psychologist

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