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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

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
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
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
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 care6
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 care7
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 care8
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
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 care10
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
Promoting Innovation and Change
  • Build on history of successes
  • Identify community needs
    • Example: MHASI Survey Handout
  • Identify partners
strategies for change formation
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 formation13
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 formation14
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 formation15
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 formation16
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
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
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 components20
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 components21
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 components22
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 components23
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
chestnut mission statement
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.