Integrated Care at The Providence Center 2014. Presented by: Nelly Burdette, PsyD Director of Integrated Care The Providence Center. Background. Rhode Island’s largest community mental health organization with an annual budget of $42 million.
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Nelly Burdette, PsyD
Director of Integrated Care
The Providence Center
Rhode Island’s largest community mental health organization with an annual budget of $42 million.
In 2013, we served 12,777 people with services provided statewide through 14 service locations in Providence, Burrillville, Cranston, Pawtucket, and Warwick, and 13 client residences in Providence.
5 main service divisions
TPC’s main administrative offices and adult outpatient services on North Main Street in Providence.
Race and Ethnicity
Native American: 3%
Medicaid UBH: 19%
Medicaid NHP: 17%
Private: 2%TPC Demographics
Behavioral Health within
Primary Care Setting
Increase awareness of behavioral health care issues for both provider and patient
Increase access to
screening and intervention
Improve chronic disease management
at largest PCHC site
Providence Community Health Centers at Prairie Avenue Collaboration
Outpatient child and adult practice embedded within PCHC with bilingual therapist and bilingual child/adult psychiatrist
New Health Home currently piloting
Top three behavioral health
diagnoses within FQHC (PCHC @ Prairie)
Male & Female > 18 y/o
Top three physical health diagnoses within embedded medical center of CMHC (PCHC @ NM)
Male & Female > 18 y/o
Primary Care within
Mental Health Setting
Improve morbidity and mortality of consumers with mental illness and addictions
Decrease barriers to access to physical health care for consumers with behavioral health issues
Improve health literacy for both providers and clients
Providence Community Health Centers at North Main Street
Opened June 2011
Physician, nurse, medical assistant & health centerdirector
TPC-employed integrated care manager with a health literacy focus
“We treat complex patients who have complex problems, many of whom have not sought health care for a long time. I talk with my patients about about understanding what they have to do to get healthy and how I can support them.”
-Dr. Tariq Malik, M.D., M.P.H., primary care physician at Providence Community Health Centers at North Main
Individualized fitness and healthy lifestyle assessment performed by the health mentor for every participant
Fitness plan, including eating, exercise, and health promotion
Weekly individual meetings with a health mentor to participate in fitness activities from walking to gym attendance
SAMHSA funded PBHCI Grant
Psych hospitalization and psych ER use significantly decreased
Medical hospitalizations and medical ER visits increased.
All types of hospitalizations showed a net decrease (156 days less net)
428 days to 256 days = $122,120 savings
National average $710 per day2
72 times to 33 times = $27,300 savings
National average $700 per day1
49 days to 24 days = $24,250 savings
National average $970 per day2
$173,670 savings for 350 individuals designated as SPMICost Savings (n=350)
Clients belief that they can communicate with physicians,
manage disease in general, manage symptoms of disease, increase nutritional abilities, improve psychological well-being
has significantly improved over one year with nurse care coordination.
If alcohol screening (AUDIT) initially at-risk (>8) AT BASELINE, there was a statistically significant decrease in risk after one year of nurse care management participation
If depression screening (PHQ-9) initially in the moderate range (>10) AT BASELINE (n=158), there was a statistically significant reduction over the course of one year.
assist pt in focusing on the top 3 issues he/she would like addressed today
review logistics of PC: prepare pt about length of appt, any longer than anticipated wait times, etc.
review pt’s mood, new stressors and any emotional issues that could be impacting physical health
At the same time, physician reviews an interagency form:
includes pt’s mental health diagnoses, psychiatric medications and any relevant notes from mental health team
Health Literacy: Before the Medical Visit
be a witness to the points of difficulty between pt and physician
provide support to the physician should the pt experience difficulty communicating
provide support to the pt should pt experience difficulty understanding medical concepts or recommendations
Health Literacy: During the Medical Visit