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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

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

  • 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
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


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 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