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Minnesota Collaborative Psychiatric Consultation Service. L. Read Sulik, MD, FAACAP Senior Vice President – Behavioral Health Services Sanford Health read.sulik@sanfordhealth.org 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


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? Psychiatric Consultation Service?

  • 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 Psychiatric Consultation 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
M Psychiatric Consultation Service?hINT 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
M Psychiatric Consultation Service?hINTProject Organization

Mayo Clinic subcontracts

to MhINT Partner sites

and other subcontractors

Regional teams
Regional Psychiatric Consultation Service?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 Psychiatric Consultation Service?

  • 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 Psychiatric Consultation Service?

  • 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 Psychiatric Consultation Service?

  • 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 Psychiatric Consultation Service?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 Psychiatric Consultation Service?

  • 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 Psychiatric Consultation Service?

M h int will not encourage pcp management of the following
M Psychiatric Consultation Service?hINT 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 Psychiatric Consultation Service?

  • 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 Psychiatric Consultation Service?

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 Psychiatric Consultation Service?-to-Face Consultations

Face to face consultations1
Face-to-Face Psychiatric Consultation Service?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 Psychiatric Consultation Service?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 Psychiatric Consultation Service?

  • 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: read.sulik@sanfordhealth.org

    • Telephone: 701 234 4124