Connecting Primary Care and Specialty Mental Health: Moving from Competition to Collaboration

Connecting Primary Care and Specialty Mental Health:

Moving from Competition to Collaboration

Cynthia Cartwright, MT RN MSEdMelissa Cormier, LCSWMary Jean Mork, LCSWOctober 11, 2013CFHA Session G1b

…Or, acknowledging our different lenses and planning to bring it all

into a shared focus.

Workshop Outline

Description of present culture rift (10 min) Identification of potential strategies to reduce

rift at all levels (10 min) Activity (10 min) Planning for your next steps (10 min)

Learning Objectives:

Attendees will be able to: Identify the cultural and organizational differences

that influence the present mistrust between health care providers and mental healthcare providers

Develop strategies to target and reduce the culture rift at all levels: from leadership to the individual practitioners

Who are we?

Maine - Where we live and work.

On a bad day….…connection between primary care

and mental health looks like….

On a good day……connection looks like…

What do you need to look at differently?

Connecting at all levels

Leadership

Practice/Program

People

Leadership Challenges

Financial – history of “carve-out’s” and separate budgets

Different rules and regulations Competing priorities Turf

Leadership Strategies

Look for linkages – e.g. ACO development, Health Homes Foster champions and change agents Maximize connecting opportunities - locally and

regionally Support emerging leaders Communicate respectfully and often Appreciate competing demands, but also where linkage

becomes important Build relationships

Practice Level Culture Clash

Primary Care Mental Health

Pace 15 minute appointment 50 minute sessions

Setting Exam room Office

Language “Patient”

Diagnosis, medical terminology, complaints

“Client”

Assessment, mental health terminology, issues

Hierarchy Clear – Dr. in charge Diffuse – Administrator in charge with med director

Flow Flexible patient flow Scheduled client flow

Focus Specific focus on presenting problem

Traditional comprehensive approach to treatment

Documentation Brief, SOAP structured Progress and process recording, Comprehensive

Privacy of Info HIPPA Rights of recipients,

42 CFR part 2, etc.

Finances Medical bill Prior authorization, mental health carve-outs

Mental Health & Primary Care Differences

What did we learn?

There’s concern about time to talk No emphasis on meeting in person Desire by both to have a “working relationship” Communication is key Patients/clients are not a barrier

Practice/Program Strategies

Set up targets for improved access Clarify expectations and aim for timely

communication Set up regular meetings Promote the use of standardized screening &

assessment Increase use of technology Build relationships

Strategies for Mental Health Programs

Client/PatientIdentify Health Status and PCP coverageIncrease the number of clients with a PCPInclude Releases of Information to PCP’s as part of intakeAssist clients in using primary carePracticeEducate PCP’s about mental health problemsEstablish process to routinely coordinate careEstablish method to identify clients at high riskCreate process for collaborative planning for high risk populationsBuild relationships

People Challenges

Attitudes and experience Struggles with communication Personalities Competing demands Geographic separation Turf

People Strategies

“No wrong door” Collaborative learning

– Teams and disciplines come together– Introductions and ongoing informal connecting

Offer site visits, conference calls, Webinars Be responsive Foster relationships/communication

Connecting at all Levels Leadership: The right culture - an agency-wide culture shift is

necessary to make these changes. Business as usual will hamper integration.

Practice: The right training - provide staff the tools and knowledge to work within an integrated health program.

People: The right people - all staff, down to the front office, must understand the importance of integrated services and why the agency provides these services.

From the SAMSHA-HRSA Center for Integrated Health Solutions

Tips for Connecting

Build and nurture relationships Focus on communication and coordination Clarify Roles Establish shared goals

Lessons LearnedLeadershipBe aware of organizational power and politicsMoney matters

Practice/ProgramAcknowledge when turf is being challenged, or protectedPause to look at the big picture, and remind others to do so

PeopleExpect variability; some people will see the larger picture, others will notPatients/clients and families are valuable teachers in the collaborative process

Lessons Learned – at all levels Everything takes much more time than you thought it would

(or should)! Foster linkages and relationships and sustain them Be willing to work at many levels at the same time There will be blind spots. Watch for them. Grab all opportunities: even the smallest steps can create

positive change Be open to what is not working and why: be prepared to

make significant changes in perception and direction

Tools for Connecting at the Practice Level

Readiness survey: for primary care and Readiness Survey with Change ideas

AIMS Center “Staff Self-assessment”: from the IBHP Partners in Health Interagency Toolkit

Tips: for Connecting Primary Care and Behavioral Health Organizations

Activity

What can you do to make improvements in the connection, and how will you start this process?

What are you willing to commit to doing when you get back to work?

Resources www.thenationalcouncil.org – the National Council for

Community Behavioral Healthcare www.ibhp.org – Integrated Behavioral Health Project www.mainehealth.org/mentalhealthintegration

Contact Information

Cynthia Cartwright, MT RN MSEd cartwc@mainehealth.org

Melissa Cormier, LCSW cormim@springharbor.org

Mary Jean Mork, LCSW morkm@mmc.org