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Department of Behavioral Health and Intellectual disAbility Services June 25, 2013. Eleventh Street Family Health Center 0 f Drexel University. Patricia Gerrity , RN PhD, FAAN. B. Community Partnership. Started 1996

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Department of Behavioral Health and Intellectual disAbility Services June 25, 2013


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department of behavioral health and intellectual disability services june 25 2013

Department of Behavioral Health and Intellectual disAbility ServicesJune 25, 2013

Eleventh Street Family Health Center

0f Drexel University

Patricia Gerrity, RN PhD, FAAN

community partnership
Community Partnership
  • Started 1996
  • Residents of four public housing developments in Lower North Philadelphia
  • Community Driven
  • Had to develop trust
  • Community was tired of being assessed and surveyed
slide5
“Man is the only animal that cries because man alone sees the difference between what is and what could be”

Victor Hugo

integrative health care
Integrative Health Care

To create a seamless engagement by patients and caregivers of the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health throughout the lifespan.

primary care redesign
Primary Care Redesign
  • More than adding services to primary care, or simply adding traditional mental health philosophies, skills & interventions in a new setting
  • Requires systems redesign
  • Providers shift from independent clinician to a functioning team member
  • Each member of the team must understand enough about the discipline & training of team members to communicate effectively and to design collaborative interventions that will meet the needs of the patient.
slide15
Every great change must expect opposition because it shakes the very foundation of privelege.Lucretia Mott
integrated team
Integrated Team
  • Family nurse practitioner
  • Clinical nurse
  • Primary behavioral health consultant
    • Child & adult
    • Couples & Family Therapist
  • Generalist social worker
  • Health educator
  • Nutritionist
  • Complementary & integrated therapist
  • Physical therapist
  • Fitness trainer
  • Nurse family partnership home visitors
  • Creative arts therapists
  • Attorneys
characteristics of integrated care
Characteristics of Integrated care
  • High degree of collaboration and communication
  • Establish comprehensive treatment plan to address biological, psychological and social needs of patients
shared language
Shared Language
  • Project LEAP- Learning through Effective Ambulatory Practices
  • Integrated care
  • Complementary & integrative therapist
  • Architects- engagement room (ER)
lexicon for behavioral health p rimary care
Lexicon for Behavioral Health & Primary Care
  • Peek CJ and the National Integration Academy Council

AHRQ Pub No 13-IPOOO1-EF

what is it
What is it?
  • The care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systemic and cost effective approach to provide patient centered care for a defined population.
the care may address
The care may address
  • Mental health conditions
  • Substance abuse
  • Health behaviors
  • Life stressors and crises
  • Stress related physical symptoms
  • Ineffective patterns of health care utilization
slide23
How
  • A practice team tailored to the needs of each patient and situation
  • With a shared population and mission
  • Using a systematic clinical approach ( and a system that allows the clinical approach to function)
supported by
Supported by
  • A community, population, or individual expecting that behavioral health and primary care will be integrated as a standard of care
  • Supported by office practice, leadership alignment, and business model
  • Continuous improvement and measurement of effectiveness
microsystems
Microsystems
  • A small interdependent team defined at the level of each patient that forms to meet particular patient and family needs
  • The microsystem changes as the needs of the patient and family shift
creative arts therapies
Creative Arts Therapies

Creative Arts Therapies (CATs) are the psychotherapeutic use of movement/dance, music and art to further the emotional, cognitive, physical and social integration of the individual. CATs are behavioral health therapists who integrate evidence from fields like neuroscience, human development and behavior, counseling, psychopathology and multiculturalism to develop their practice of assessment and treatment. Both individual and group therapy is provided. CATS serve as primary counselors for our patients, and treat in conjunction with talk therapists, physical therapists, nurse practitioners and the nutritionist, for example.

behavioral health fpcn
Behavioral Health, FPCN
  • Licensed social workers, psychologists and psychiatrists offer diagnostic assessments; psychiatry services including medication evaluation and management; short-term or long-term individual talk therapy for adults and talk and play therapy for families, children (ages 4 and up) and adolescents.
b ehavioral health programs
Behavioral Health Programs
  • Co-located outpatient behavioral health
  • BHC Adult
    • ESBIRT
    • Trauma
  • BHC children & families
  • Creative arts therapy
  • Complimentary therapies
    • MBSR
    • Yoga
    • Mediation
  • Chronic pain- Power Over Pain
  • Intensive Care Management
sbirt
SBIRT
  • Screening, Brief Intervention, & Referral to Treatment
  • Collaboration with the

Treatment Research Institute

sbirt1
SBIRT
  • Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
  • Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
  • Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.
power over pain
Power Over Pain
  • Chronic Pain Resource Center
  • You are worth more than your pain!

Empower yourself to be well!

Goals:

  • Learn how to live with chronic pain.
  • Managing the different aspects of pain experience.
  • Create a safe and open learning environment where there is no judgment.
  • To empower patients to manage their own pain when they are at home doing the things they want to do.
power o ver pain
Power Over Pain
  • Clinical nurse
  • Behavioral health consultant
  • Physical therapist
  • Complimentary & integrative therapist
  • Creative arts therapists
  • Dance /movement
slide42

The Goals of The Porch Light Initiative

Shed light on challenges faced by those with behavioral health issues, reducing stigma and encouraging empathy among fellow community members

Create a network of services for the benefit of individuals and families that heightens awareness of behavioral health resources and increases access to treatment

Build a team of artists, service providers, individual participants, and other stakeholders that collaborate on transformative public art projects which encourage community ownership and pride and catalyze positive changes in neighborhoods 

adult bhc1
Adult BHC
  • Monitoring and supporting people with chronic physical illnesses
  • Care management for depression or other behavioral conditions
  • Skills in patient activation, goal setting, motivational interviewing and fostering health behavior change.
  • SBIRT- Treatment Research Institute
pediatric team
Pediatric Team
  • Behavioral health consultant PsyD
  • Family & child supports coordinator
  • FamilyNurse Practioner
  • Midwife
  • Resilience
centering model
Centering Model
  • Incorporation of
    • Assessment
    • Education
    • Support
  • Provided by an interdisciplinary team in a group setting
centering parenting
Centering Parenting
  • Babies grouped by age
  • Care for mom and baby in same visit
  • 6-8 parent-baby dyads per group
  • 2 hours with practitioners
  • Focus on development, safety, nutrition, family
relationship based practice
Relationship Based Practice

Results in early identification of developmental, behavioral and health problems – can receive early intervention

building agency capacity in program evaluation
Building Agency Capacity in Program Evaluation

Funded by:

Scattergood Behavioral Health Foundation

Consultation provided by:

Yale School of Medicine

Consultation Center

scattergood project
Scattergood Project

Building Agency Capacity

  • Focused on Evaluating Centering Program
    • Well-child program in both group and individual sessions
    • Multifaceted role of the PBHC within this program addressing the emotional, mental, and behavioral health of mothers and their children.
    • Skills gained will be used to develop and assess other programs at the center
patient centered wellness tracker
Patient Centered Wellness Tracker

Screenings used to focus visits and collect data.

slide59

Scores from the SF-36 and GAD-7 after completion of the MBSR Program

** = highly significant improvements

* = significant improvements

challenges
Challenges
  • Space
  • Time for team meetings
  • Reimbursement- centered on primary care clinical encounter, if no DSM diagnosis
  • Lack of shared care plan
next steps
Next Steps
  • Health services researcher to join team in October
  • Develop comprehensive screener and visual report form on PCWT
  • All new patients seen first by BHC, review screening and help plan individualized care
  • PAM, GAD7, PHQ9, ACEs, SBIRT, SF36