Minnesota collaborative psychiatric consultation service
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Minnesota Collaborative Psychiatric Consultation Service. L. Read Sulik, MD, FAACAP Senior Vice President – Behavioral Health Services Sanford Health [email protected] Clinical Associate Professor Department of Psychiatry, University of Minnesota Clinical Associate Professor

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Minnesota Collaborative Psychiatric Consultation Service

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Minnesota collaborative psychiatric consultation service

Minnesota Collaborative Psychiatric Consultation Service

L. Read Sulik, MD, FAACAP

Senior Vice President – Behavioral Health Services

Sanford Health

[email protected]

Clinical Associate Professor

Department of Psychiatry, University of Minnesota

Clinical Associate Professor

Department of Clinical Neuroscience, University of North Dakota


Background

Background

  • Minnesota background efforts

  • Minnesota 2006 Legislation

  • Minnesota 2010 Legislation to fund statewide psychiatric consultation service

  • Drug threshold workgroup

  • Minnesota Psychiatric Consultation Workgroup

    • Children’s Psychiatric Consultation Protocols workgroup

    • ADHD subgroup

    • Bipolar subgroup

    • Differential diagnosis, including trauma, anxiety disorders and disruptive behaviors subgroup

    • Eating disorder subgroup

    • Substance abuse subgroup

    • Triage subgroup


What is m h int mental health integration transformation program

What is MhINT?Mental Health Integration & Transformation Program

  • A partnership w/ Minnesota healthcare organizations and additional support partners:

    • Healthcare Systems: Mayo Clinic, Sanford Health, Prairie Care, Essentia (5th partner TBD)

    • Non-profits: Minnesota Psychiatric Information and Outreach (MPIO), REACH Institute

    • Project Management Consultant

    • Videoconferencing Vendor


What is the purpose intent of the minnesota collaborative psychiatric consultation service

What is the Purpose/Intent of the Minnesota Collaborative Psychiatric Consultation Service?

  • To increase quality and access to children’s mental health services across the state of Minnesota by…

    • Increasing primary care providers’ (PCPs’) skills and willingness to manage children and adolescents with mild-moderate mental health problems

    • Creating linkages and partnerships between primary care and specialty mental health providers

    • Increasing rapid access for selected face-to-face consultations

    • Reducing problematic prescribing practices via case-specific support and consultation

    • Building partnerships among Medicaid, private insurers, healthcare organizations, and providers to facilitate sustainability


Why is the service needed

Why is the Service Needed?

  • Traditional CMEs, written guidelines, and “hit-and-run” workshops and lectures are generally ineffective.

  • Evidence-based prescriber training methods need to focus on skills (not factual knowledge), and must address obstacles encountered in practice.

  • Effective training programs must use collaborative learning partnerships, vs. “one-down” relationships, and use PCP role models as co-teachers, similar to those being trained.


How will the service achieve its purposes

How Will the Service Achieve Its Purposes?

  • Targeted outreach to providers;

  • Systematic and regular communications to providers about available services and training opportunities;

  • Linkage assistance to available services;

  • Hands-on coaching, skills training, and information support;

  • Same-day phone consultation services (both voluntary and mandatory consultations); and

  • Rapid face-to-face evaluations for “emergent” cases.


M h int innovative approaches

MhINT Innovative Approaches

  • Web-based tool that allows providers to identify and link families to community resources;

  • State-of-art video-teleconferencing available at no cost to internet-linked healthcare providers state-wide;

  • “Pathway” to sustainability, with Medicaid codes approved for use by healthcare providers;

  • Creation of primary care “champions” who can in effect increase the state’s mental health manpower


M h int project organization

MhINTProject Organization

Mayo Clinic subcontracts

to MhINT Partner sites

and other subcontractors


Regional teams

Regional Teams

  • 5 regional healthcare system teams, located strategically across the state

  • Each team consists of:

    • >2 Child/adolescent Psychiatrists (CAPs)

    • >1 Triage Mental Health Professional (TMHPs)

    • Other support staff as needed

  • Multiple team members enable cross-coverage within and across sites


Leadership planning and timetables

Leadership/Planning and Timetables

  • Weekly EC Meetings

    • Co-Chairs: 1 Site Principal, Linda Vukelich

  • Partnership with by-laws guiding the collaboration

  • Subcommittees and Assigned Tasks:

    • Database, Website, REACH adaptations, Electronic Communications, CAP/TMHP Training, PR/Outreach, Program Evaluation

  • Start-up phase June/July

  • August 1 – December 31, 2012, 3-4 sites only

  • January 1, 2013, and beyond: 5 sites


Web based tools

Web-Based Tools

  • MhINT (via MPIO) will support the creation ofa web-based tool that allows providers to identify and link families to available community mental health resources

  • Regularly updated by MhINT Team & MPIO

  • Publicly available


Reach training

REACH Training

  • Hands-on, with role plays and extensive practice

  • 2 days of face-to-face training with 15-30 clinicians, with 2-3 trainers, followed by:

  • 6-12 months of twice-monthly phone call consultation and support, 1-1.5 hours/call

  • Individual case presentations, with learning and risk-taking shared among peers

  • 6 years in development, used in NYS, Nebraska, North Carolina


Hd video c onferencing over the internet

HD Video Conferencing over the Internet

  • Secure – HIPAA compliant

  • PC, Mac, iPad, iPhone & Android

  • Can interoperate with traditional video conferencing technology


Video conferencing services

Video conferencing Services

  • Will likely include:

    • Training

    • Collaboration between and within MhINT partners and DHS

    • Communication between primary care doctors and specialty mental health providers

    • Potentially some patient consultations


Consultation services

Consultation Services


M h int will not encourage pcp management of the following

MhINT will not encourage PCP management of the following:

  • Psychosis

  • Suicidalitybeyond minimal risk

  • Aggression involving serious injury to others or serious destruction of property

  • Clear Bipolar I disorder

  • Substance abuse/dependence


Work flow for phone consultations

Work Flow for Phone Consultations

  • Triage mental health professional (TMHP) takes the initial phone call and responds to calls within their scope of training and expertise.

  • If a child and adolescent psychiatrist (CAP) is needed/requested, the covering CAP returns the phone call at scheduled time (same day).


Hipaa i

HIPAA I

Voluntary phone calls are consultations to the primary care provider (PCP), as well as a clinical service to patients.

PCPs will maintain records of the consultation, and ensure patient confidentiality and HIPAA-compliance. Protected health information (PHI) NOT needed for voluntary consults.

De-identified demographic and clinical information can be used to provide evaluation of the project.


Face to face consultations

Face-to-Face Consultations


Face to face consultations1

Face-to-Face Consultations

  • Selected cases will be seen for a face-to-face (or possibly, telepsychiatricif the patient is geographically distant) consultation with a MhINTchild/adolescent psychiatrist.

  • Face-to-face (FTF) evaluations will be scheduled within 1-2 weeks with the local child/adolescent psychiatrist.


Face to face evaluations are consultations only

Face to Face Evaluations are Consultations Only

  • Face to face evaluations are consultations only, with follow-up as needed by PCPs.

  • Patients cannot be followed by CAPs for ongoing treatment and medication management.

  • PCPs will need to apprise patients and families about this.


Resources contact info

Resources & Contact Info

  • DHS Website: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_158267

  • L. Read Sulik, MD, FAACAP

    • Senior Vice President – Behavioral Health Services, Sanford Health

    • Email: [email protected]

    • Telephone: 701 234 4124


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