The journey to integrated mental health aging systems of care
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The Journey to Integrated Mental Health/Aging Systems of Care Presented by Lee Fraser, MA, RNC, QMHP Recognized by the American Society on Aging and Pfizer Medical Humanities for Innovation and Quality in Healthcare – Awarded 2005 The University of Kentucky Sanders Brown Center on Aging

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The Journey to Integrated Mental Health/Aging Systems of Care

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The Journey to Integrated Mental Health/Aging Systems of Care

Presented by

Lee Fraser, MA, RNC, QMHP

Recognized by the American Society on Aging and Pfizer Medical Humanities for Innovation and Quality in Healthcare – Awarded 2005

The University of Kentucky

Sanders Brown Center on Aging

23rd Annual Summer Series on Aging

June 12-14, 2006


  • By 2030 - the US population over 65 will increase from 13% to 20% (a 7% increase)

  • 1 in 5 community based seniors have at least one mental health diagnosis*

  • This figure will more than double by the year 2030*

*Klap, et al, 2003

* Bartles, 2004

Scope of Problem

  • Less than ½ receive treatment*

  • Non-treatment increases risk of health complications, poor medical treatment response, mortality, caregiver burnout, and overburdened systems

* Bartles, 2004

Promising Potential

  • Most psychiatric illnesses are 80% treatable in elders

  • Culture of care is in transformation

  • Model integration projects are available

    • Demonstrate positive outcomes

    • Can be replicated

Reasons for Integrated Care

  • National imperatives for collaboration

  • Outcomes research positive for outreach model and collaborative care*

  • Built in referral base

*Bartles, 2004

Reasons for Integrated Care

  • Early detection, enhanced access, reduced health risk, shared cost potential, decreased caregiver burden

  • Mental health providers potential for increased knowledge of older adults and their services

  • Aging service providers gain mental health skills and resources

Reasons for Integrated Care

  • Benefits to Elders

    • Cohesive and informed care

    • Early intervention

    • Reduced stigma

    • Enhanced self-care potential

    • Prevention of premature institutionalization

    • Promotion of interdependence

Reasons for Integrated Care

  • Model programs obtain:

    • Outreach expansion

    • Multidisciplinary mix

    • Shared synergy – cost

    • Shared risk

    • Expanded service capacity for prevention, intervention, crisis, education, family care and access to resource

Retrospective on Systems of Care

  • Mental health treatment evolved from non-treatment to med treatment

    • Use of psychotropic medications(1950’s)

    • Major deinstitutionalization (1960’s)

  • Gero Psychiatry has approximately 60 years of history

Retrospective on Systems of Care

  • Aging services evolved in 30’s and 60’s

  • Mental health services once grant funded are now fee for service

  • Mental health programs for seniors highly vulnerable to fee for service

Promoting Innovation and Change

  • Build on history of successes

  • Identify community needs

    • Example: MHASI Survey Handout

  • Identify partners

Strategies for Change/Formation

  • Consider highest purpose and needs of all partners

  • Relationships are essential and critical to success

  • Consider universal needs first – then unique aspects

  • Learn the essential elements of each program

  • Get administrative buy-in

Strategies for Change/Formation

  • Start one small joint venture

  • Find and promote champion agencies for change

  • Find and build leaders

  • Use model programs as a template

    • Example: Featured Program Handout

  • Consider perceived threats of integration

  • Seek consultation

Strategies for Change/Formation

  • Rational versus Relational - models for change:

    • Rational model provides information and anticipates change

    • Relational model focuses on the theories of “diffusion” and “stages of change”

Strategies for Change/Formation

  • Communicate early and often

  • Coalitions, partnerships, collaborations, services, and entire systems are built on Relational models

  • Influence one key member of a group

  • Changes move in a linear fashion in the short term but move in concentric circles of broader influence with longer lasting impact

Strategies for Change/Formation

  • Diffusion Theory - means by which innovations are spread throughout a population, adopted over time

  • Change is a “social process”

  • Parallel Process - theory can be applied to whole systems as well as individuals

Three Principles of Innovation

  • Innovations are “anything” new to a group

  • Interpersonal influence peaks when rate of adoption is at a max

  • Adoption of innovation occurs in stages

    • Awareness, persuasion, initial action, full implementation, confirmation/reinforcement


  • Model Program Elements (see handout)

  • Discussion

  • Short Break

Model Program – 3 Key Components

  • Systems Integration – the first step to growth of older adult programs

    • Affiliate at all levels – medical, education, policy, advocacy

    • Balance player mix

    • Consumer involvement

    • Revisit needs and scope

    • Provide a product – agree to be outcomes driven

    • Obtain TA/MIS support

Model Program – 3 Key Components

  • Direct Service/Consultation

    • Outreach 90% of Direct Service Base

    • Multidisciplinary staff mix – medical, social

    • Include board certified Gero Psychiatrist Medical Doctor

    • Use medical alternates – NP’s, PA’s

    • Extend outreach – telemed, consultation

    • University linkage – interns, research

    • Partner with F.Q.H.C. clinics

Model Program – 3 Key Components

  • Integrate with primary care medical groups

  • Peer-to-peer support groups

  • Include caregiver, prevention support

  • Use Aging CCU’s and Elder Abuse Units as referral base

  • Determine levels of client engagement

  • Integrate within mental health programs within comprehensive agencies

Model Program – 3 Key Components

  • Education and Training

    • Train everyone at all levels

      • Include prevention and recovery

      • Wellness

      • Normative aging

      • Most common diagnoses

      • Use of service system

      • Code mandates

Model Program – 3 Key Components

  • Education’s System Integration – Cross train on Best Practices Models

    • In-services (other providers)

    • Area wide conferences

    • State conferences

    • Web page, designated events/dates, fact sheets

  • Develop a manual and CD’s

  • Assure quality graphics, logos and program brochures

The Journey is Realized

  • Group Exercises

Chestnut Mission Statement

  • Making a difference: improving quality of life through excellence in service.

Chestnut Vision Statement

  • Chestnut Health Systems will be a leader in the development and delivery of superior human services.

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