[PC-BH-Integration] Patient flow models, staffing ratios

[Bill Schlesinger]

That's where the care manager comes in for us.  The care manager provides
'brief therapy,' not longer sessions, and can be available within about
10-20 minutes if not immediately (including travel time between sites if
required).  That wait time is (regretfully) in line with the wait time for
other services during a visit.  If the provider is sufficiently concerned,
they may opt to wait (significant emotional distress emerging in the
encounter).  Usually the patient will wait in the exam room.  CBT therapy
sessions are scheduled after an interview with the care manager, if that's
appropriate in the diagnosis.  

 

Most 'easy diagnoses' are initially flagged at intake with the PHQ-9, so
there's some ability to alert the care manager if needed.

 

Case load for our care manager is optimal at about 80 active individuals.
She has carried up to 150 but with impact on documentation time and some
negative impact on overall decrease in symptoms (still better than we were
doing without a care manager).  Some other pilots in Texas have limited case
load to 30; conservative from our perspective, but with good outcomes.  

 

Case load is expected to cycle through intake and care plan, treatment
phase, and relapse prevention.  We count the first two cycles as 'active'.
We currently have 1 FT care manager (Licensed MSW - similar to CMSW)
covering two sites, with 1.5 FTE therapists for about 8000 unduplicated
patients.  We're planning on adding another site and having a Community
Health Worker (promotora) trained and supervised by the care manager for
that site - about 3000 anticipated participants.

 

Bill Schlesinger
Project Vida
3607 Rivera Ave
El Paso, TX 79905
(915) 533-7057 x 207
(915) 490-6148 mobile
(915) 533-7158 fax
bschlesinger.pv at tachc.org

  _____  

From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Nancy
Halloran
Sent: Thursday, January 29, 2009 5:30 PM
To: pc-bh-integration at lists101.his.com
Subject: [PC-BH-Integration] Patient flow models, staffing ratios

 


Thank you all for your help! 
I have another question-- Are there any models/tools written up providing
"how-to" level advice regarding: 

- patient flow (for instance, if the behavioral health provider is seeing a
patient and a primary care provider wants to do a warm handoff, how is that
done? just as one example)

- staffing ratios and case loads

Thank you !





Nancy S. Halloran, MPH
Program Development, Proposals, & Project Management
Health Equity Partnership & Community Institute for Healthcare Equity
614 Grand Ave, Suite 400
Oakland, Ca 94610

510-847-3833
510-217-5940 (fax) 

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