Primary Care - Northeastern University

Report
Establishing an Integrated Behavioral Health Program
and Practicum Site in a Community-Based Primary Care
Center
Christina S. Lee, Ph.D.
Dept. of Applied Psychology
Northeastern University, Boston, MA
IBH Program Director
South End Community Health Center, Boston, MA
“Co-located”
2
Integration
Primary Care
• Dan Simpson, M.D.
• Tom Sterne, M.D.
• Deb Clifford, R.N.
Behavioral Health
• Laurie Goldman, Psy.D.,
R.N.
• Ray Walden, L.I.C.S.W.
• Alexander Young, Psy.D.
• Rick Silva, Pharm.D.
• Interns:
– Heather Bennett
– Atsushi Matsumoto
March, 2013
Integrated Behavioral Health (IBH) Program planning begins.
April 20, 2013
Proposal for the IBH Program and Psych Intern training submitted by Dr. Lee to the
SECHC. IBH Intern training objective is to pilot IBH training curricula for SECHC
psychology interns.
May, 2013
The curriculum for the IBH Program and the IBH Seminar series is developed.
July 1, 2013
Focus group moderated by Dr. Lee with providers (n=15; 4 Adult medicine, 2
Family medicine, 2 Pediatrics, 6 Ob/Gyn, 1 Hass Center) on perceptions of
behavioral health before IBH. Suggestions used to improve awareness, training
needs, and communication regarding the IBH Program and intern training.
July 15, 2013
IBH Program meeting with interdisciplinary providers and IBH interns
Discussed IBH referral process between provider and consultant, triage process of
linking out to care
Sept 6, 2013
First IBH intern class orientation at SECHC.
Sept 10, 2013
Introduction of IBH program to SECHC clinicians. The “Roll-Out” presentation.
The purpose of IBH and referral process is presented. Survey and focus group
findings presented.
Sept 19, 2013
IBH Seminar Series begins and IBH interns begin shadowing providers
Oct 1, 2013
IBH begins seeing patients
Nov 17, 2013
Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns
Dec 12, 2013
Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns
Timeline Year 1
IBH Planning
IBH intern seminars
Jan 25, 2014
Breakfast: IBH Program meeting with
interdisciplinary providers and IBH
interns. Providers give positive feedback
on IBH. Discussion on how to improve
referral system, and advantage of inperson referral
March 3, 2014
IBH referral process reviewed by Admin
team. Preliminary IBH data reviewed.
New patient screening tools discussed
June 3, 2014
IBH manual drafted
August 4, 2014
Procedures to gather IBH patient
satisfaction survey reviewed. Focus
group with providers planned.
Timeline Year 1,
cont.
IBH coordination
and Intern
seminars
Integrated Health Seminars 2013-2014
1. Functional Assessments and the 5As
2. Integrated behavioral health: Anxiety and depression
3. Medical literacy
4. Writing case notes for integrated care
5. Substance use assessments
6. Crisis management
7. Adult psychopharmacology in mental health, Part I
8. Negotiating behavior change in health behaviors
9. Adult psychopharmacology in mental health Part II
Integrated Behavioral Health Coverage Schedule November 2013


Location: SECHC PAATHS Office 2nd Flr
IBH Consultant Contact Number: 857-301-0154

Common Reasons for Referral: Stress, Insomnia, Anxiety/Fears, Chronic Pain, Mild Depression, Headache, Anger,
Relationship Problems, Grief or Bereavement, Low Back Pain, Diet (weight loss, dietary adherence problems), Tobacco
Use, Exercise, Chronic Illness Management: Diabetes, GI Problems, COPD, Medication Adherence

Services: Consultation (30 minutes) for assessment and behavioral health treatment planning, recommendations, and
interventions

Purpose: To help patients develop practical knowledge and skills to promote and improve physical and emotional health

Contact Procedure: Intern provides primary coverage - CONTACT FIRST. Staff provides back-up coverage when necessary

Referral Procedure: Complete IBH Referral Form found in EMR under Letters tab, and (when possible) flag IBH consultant
on call. Introduce patient to IBH consultant and provide IBH consultant with any relevant patient information

General Hours of IBH Coverage: 9:00 - 12:00 (AM) and 1:00 – 4:00 (PM)
Monday:
AM
INTERN- Heather Bennett
STAFF- Richy Villa
CONTACT: 857-301-0154
CONTACT: ext. 7671
PM
INTERN- Heather Bennett
STAFF- Richy Villa
CONTACT: 857-301-0154
CONTACT: ext. 7671
*Indicates individual is Spanish speaking
Mental Health Interpreter Services are available for non-Spanish speaking consultants
IBH Referral Form
Date: ________________
Patient Name: _________________________ DOB: _________________________
Preferred Language: [ ] English
[ ] Spanish [ ] Other: _______________
Referring Provider: ____________________________
Referral Type:
[
] Routine
[
] Urgent-seen in 2-3 days
[
] Emergent
Reason for referral:
[ ] Anxiety
[ ] Grief
[ ] Depression
[ ] Recent Psych Hospitalization
[ ] Smoking Cessation
[ ] ADHD/ADD Evaluation
[ ] Diagnostic Evaluation, e.g. Bipolar, ADD, other [ ] Substance Abuse
[ ] Other: _____________________________________________________________
Referral to:
[ ] Pharm D: For comprehensive medication management for anxiety, depression, other psychiatric conditions, access to
Specialty BH 3rd floor
[ ] CAMI Study: Alcohol use disorders, substance use
[ ] Integrated BH Consultant: For evaluation and short term counseling; e.g. anxiety, depression, relaxation training,
grief, sleep hygiene, smoking cessation, substance use
[ ] Specialty Behavioral Health Service 3rd floor
[ ] PLEASE CALL PATIENT: Patient could not see clinician today, but wished to be called
Telephone number (confirmed with patient): ________________________________
NOTE:
IBH will usually see patient up to 3 visits and will refer to Specialty Behavioral Health, 3rd floor, if patient needs long term
management.
Importance of in-person referral
Referral
Type
Pts seen
Remaining to be
seen
Total
Paper
52 (36%)
93
145
Verbal
33 (89%)
4
37
Flag
2
1
3
Paper &
Verbal
4
0
4
Total
91
98
189
Patient Satisfaction Survey*
*Based on the Client Satisfaction Survey (citation)
1. How would you rate the ease of making an initial appointment with the Health and Wellness
consultant?
(1) Poor
(2) Fair
(3) Good
(4) Excellent
2. How would you rate the ease of making a follow-up appointment with the Health and Wellness
consultant?
(1) Poor
(2) Fair
(3) Good
(4) Excellent
3. Did you get the kind of help you wanted from the Health and Wellness consultant?
(1) No, definitely not (2) No, not really (3) Yes, generally (4) yes definitely
4. How satisfied are you with the help you received from the Health and Wellness consultant?
(1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied
5. If a friend were in need of similar help, would you recommend the health and wellness consultant
to him or her?
(1) No, definitely not (2) No, I don’t think so (3) Yes, I think so (4) Yes, definitely
6. Has the help you received from the Health and Wellness consultant helped you to deal more
effectively with your concerns?
(1) No, seemed to make worse (2) No, didn’t really help (3) No, didn’t really help (4) Yes, a great deal
7. In an overall, general sense, how satisfied are you with the help you have received from the Health
and Wellness consultant?
(1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied
8. If you were to seek help again, would you come back to see a health and wellness consultant?
(1) No, definitely not (2) No, I don’t think so (3) Yes, I think so (4) Yes, definitely
Student education and training
•
•
•
•
IBH Manual drafted
Seminars planned
Supervision issues and coverage
Smaller cohort
Counseling PhD Student participation and
development
• IBH Internship Track at SECHC
– 6 Phd Level trainees
• IBH researchers: Welcome to our new
Northeastern Counseling Ph.D students. Check them
out on our website!
– Janelle Alabiso, M.A.
– Daniel Gittens Stone, M.A.
Thank You to the South End Community
Health Center, and to the Psychology
Interns for making this work possible!
Christina S. Lee, Ph.D.
Dept. of Applied Psychology
Northeastern University, Boston, MA
[email protected]
Www.Northeastern.edu/cslee

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